For the love of adventure

by Jennifer Morris PA-C  (published 2004 in a physician assistant journal) (c)

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  "How do you feel about going to Unalaska to work?"  My husband Bob asks as he looks up from his email and smiles like a cat with a feather stuck on his chin.

 "Where?" I ask not looking up while folding clothes.

  "Unalaska" He repeats getting my attention.  Now I see the sly smile. He is enjoying messing with me.
" Unalaska? Ok, but where is Unalaska ?" mispronounced by us both as oon-alaska instead of uhn-alaska..

 "I don’t know." He admits and we huddle over a computer map of Alaska. " Here is Dutch Harbor" Bob points to Unalaska about half way down the Aleutian chain on the island of Unalaska.  Eight hundred miles from Anchorage and several thousand miles from our home in Colorado.

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 Bob has my full attention now as I wonder aloud, " The scary fishing place? Discovery Channel’s   Most Dangerous Job in the World   place? Remember that program about the crab fishing in the Bering Sea?"   My grin is now matching his.  We like living Discovery Channel.  Our other job is taking tourists places. One place is to Kenya on wildlife safaris.   Discovery Channel did a show about Africa  and as our stomping grounds were displayed on television  we pointed in recognition at the familiar places. "Oh, look that’s the view at Amboseli.  See Mount Kilamajaro in the back?"   It’s a great show.  So I think Alaska would be a super new adventure.   After all we are not going to fish, we are going to give medical care to those who do.

I ask in wonder, "How did you find this?"  Bob amazes me.

 "I answered an ad that was looking for a full time physician and offered us as locums."  He slowly relates the offer in his Maine tinged accent. Mainers tend to talk in gradual sentences.  I speak Maine too having grown up there to age forty and so I wait.  Not patiently but buzzing inside with anticipation.  He adjusts a paper on the table, taps a couple keys on what I call the ‘other woman’ his beloved computer and continues.    "They need both of us for a three month contract.  Wanna go? "

 I look around at our rental apartment in the city as my face breaks out into a wide delighted grin. "Sure!"  I get on the phone to tell my adult son we are going to work in Alaska.  My voice crackles with excitement as I tell him of our new adventure.  Greg is used to this sort of thing from us and gives me his "you-go-Mom" support.  I think of zillion things needing to be done.   My list making hand is already at work organizing as I wonder if we need arctic gear.

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That first year we were living in the city as our solar house in the mountains was on hold for the winter months.  After the summer of sweating some equity into it we found the charm of hauling water, bathing outside, and cooking on a camp stove pales rapidly with the brisk fall weather.   We had finished the stone chimney with rocks from our mountain range the Sangre de Cristos plus a couple token stones that have stories of their own from Africa and Massachusetts.   It takes another post fishing season to make the house ready to live in. Working in Alaska then home to work on the house has become the norm.  This season the sauna, greenhouse and landscaping wait for us to get home in the spring.  We like having the time to put our backs into the project.

 Lifestyle Change for Life

 When we decided to stop our rat-race city life we had to commit to a major change in lifestyle.  It  meant sell our city townhouse and quit our nice secure benefited city jobs.  Gone are the long hours of ER, family practice and occupational medicine.  Gone is the security of knowing we get paid every two weeks.  Gone are our bills paid off with proceeds from the sale of the house and those final regular paychecks.  Instead of commuting to the office in Denver we went sailing in the Bahamas on our thirty-six foot sailboat.  It took a year before we came back to the work world.   For now we are done with on call and constantly being pushed to ‘produce’.  Produce should be fruits and vegetables not a stick over a medical providers head to see more patients faster.  The decision to stop commuting and stop being mortgage poor became our promise to each other.   We keep the house modest at 1500 square feet and do as much of the labor on our own as we can.   No monthly debt other than insurance, satellite television and computer.  Now we focus on temporary jobs in short bursts of work. Sometimes that means being the provider twenty four seven for awhile.   We have to be constantly looking and available to work about three months of the year, maybe four.  Rarely do we find a job that needs us both at the same time.

 We still commute

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 I tell people who ask what we do that we live in Colorado and work in Alaska.   Instead of fighting traffic every day we commute once or twice a year.  It is a bit of a commute to the island.

  Unalaska where the town of Dutch Harbor rests has a population of about 3000 local people, made up of an interesting ethnic mix of Caucasians, Filipinos, Aleuts a smattering of other Asians and a few Mexicans.  This number swells to approximately 10,000 people of all races during the height of the fishing season.  It is a United Nations mostly of the third world.  Most of our patients speak some English, but in one day I heard Arabic, Somali, Spanish, Tagalog, Russian, Japanese, Chinese, Hungarian, and a few I’ve no idea what they were speaking.  This  makes language issues a constant challenge.  Even the best English-speaking buddy who translates has trouble with medical terms like ‘surgery’ or ‘immunizations’.    Every English word for things related to fishing is known, but not the ones for medicine.  Somehow it seems to work out. We have bilingual books in many languages.  Often it is a case of a local-that-has-a-friend-and-knows-a-person that will come to the clinic to translate in a pinch.  We find the willingness to help is never stingy. 

The Iliuliuk (Ill loo lee uk )Family and Health Services Clinic in Dutch Harbor is not a hospital but well equipped.  In the Aleutian Islands this clinic is the biggest most well equipped facility.  I am pleasantly surprised to see x-ray, lab, nurses, pharmacy, exam rooms, a four bed ER and a reasonable trauma room.  Everything is clean and stocked.  I also notice the smell of fish permeates the clinic as patients gather and I am reminded of a friend once describing the smell of manure on her Nebraska farm as "the smell of money."  The fish odor is too.   Without this industry many of Alaska’s communities would turn into ghost towns.

 A Conjugal Visit Maybe?

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Bob and I try to keep our time apart down to a month or six weeks.  This trip out it will be three months unless I can finagle a visit on my days off.   Bob is on the Aleutian Island of Akutan and the only provider while I’m in Unalaska with three other providers.   We are now in A-Season,  the busiest winter fishing season.  Although Bob and I are a mere thirty miles apart over deep icy arctic waters it takes five rough hours by boat or a noisy but more efficient flight by amphibious plane called the Goose.    I will try my best to get over and visit at least once.

  In the evening we talk by phone and share the day’s stories.  I tell him about the crowd of hacking and coughing  patients at the processor dispensary that morning.   This is free clinic and a service to the employees by one of Unalaska’s biggest processor plants.  I triage and treat the illnesses that are fast and simple. The rest I send to our regular clinic for work up. It is not free at our clinic, but grant money helps with a sliding fee scale.  Bob and I are both seeing patients with nasty upper respiratory infections.  Some look like some flu too with harsh dry coughs, aching bodies and high fevers.  The exhausted workers who process the crab know time is of the essence as the crab sitting in the ship holds must be alive to keep or it will spoil.  Tons of crab.  The crab processors work eighteen-hour days, seven days a week and make more money on overtime than they could make in a lifetime at home. When the crab is finished they move onto pollack or cod and the hours are cut back.  A cushy twelve or sixteen hours with one day off a week. This work is not for the wimpy. There is a sigh of relief when the crab season is done.

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 Bob tells me about a two am panicky call for  ‘a man vomiting blood’.  He crawls out of his warm bed as he does most nights to see the patient.  We chuckle that the blood was cherry pie with a bit of Spanish rice.    I tell him about a medevac that day of a critical patient from a real GI bleed, not cherry pie. An emergency medevac runs in the tens of thousands of dollars.    Bob has been there, done that too. We talk about the overuse of ibuprofen and alcohol by the fishing industry population.

 We discuss work comp issues and the silly ones that aren’t very good actors and we talk about our family.  We chat about our first grandchild due in April with soft smiles in our voices.  I look out my apartment window at the continual drizzle.   "I miss you."

"I miss you," Bob answers looking at the fog out his own window.  

 In a way we enjoy our time apart.  It makes the heart grow even fonder.

  I have heard a story and ask Bob, "Did you know a few years ago there was a murder on Akutan when some guy had his throat cut?  He bled to death because they couldn’t medevac him out in time."  I shiver at the thought of this happening on my watch.  Bob gets very quiet thinking the same thing as I continue,    "I was asked by someone here if that could happen on this island.   I assume the question referred to bleeding to death not getting murdered."

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 "Did you set them straight?" Bob asks. We both are amazed at how innocent the public is to their risk of being so far from a hospital.  " I did."  There is no hospital, no blood to give, no CAT scan, no surgeon, and no anesthesia on this remote island. Amazingly there are a lot of saves.  The good outcomes depend on our skills but mostly on the weather.

  Weather Report- wind 10 to 100 knots, rain, drizzle, more fog and of course snow.

Coming into the island I look out the plane window at nothing.   Snow swirls around the window blurring the sky so that even the wing has vanished into the storm.   It seems like night at two PM when the plane descends.  Visibility has gone from blue sky at higher altitude to zero in the last thirty minutes.   The pilot is hoping for a peek at the runway, just enough to set us down, here on the shortest jet runway in the world.   Special training is needed to land at this airport.   Only visual approaches are made, there are no instrument landings.  Pilots love the challenge.  Passengers pray.  We get lower and lower until I feel the jet go full throttle as the landing is aborted and we ascend in a steep climb for the return to Anchorage.  The day has been six hours of travel without making our destination.  Tomorrow we will try again, and the day after that, until the weather breaks and we get in.  Those of us waiting are getting to be buddies.

One fisherman regales us with a tale of trying to get to Unalaska for fourteen days.   "This is better than being stuck on the island trying to get off" he laughs.  "Out there we had to sleep on the airport floor it got so crowded." We perversely enjoy these hardships and the tales they create.  The men swap grim stories about whose job is more dangerous, the crabbers or the cod fishers.   Everyone has tales of narrow escapes and near drowning.  I look the crowd over and wonder how many I will see as patients over the next few months.   I hope the bad weather days don’t fall on the times I need to send out a seriously ill patient.

 The weak sun in the Aleutians rarely shines for a full day. High volcanic mountains, pristine white in the winter and bright green in the summer, skirt the bays before they drop into the sea.  A blanket of cloud covers their tops. The island is like a fishbowl with a cover.    Clouds congeal into gray sponges constantly dripping when not being wrung out by wind blasting the island in a gale of rain.   Winter sunrise is a soft blur as it circles just above the horizon for six or seven hours and then settles down again for another long night.  Summers are soft days that are gloriously long.  Winter is never bitter cold, nor is the summer warm.  It is desolate and exquisite.

 On and off time

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 The North Slope is hiring for itinerant physician assistants and we apply.   Native and town clinics recruiting full timers need fill-in help.  Full timers often come and then go.  There is a pool of us out here working the holes left by resignations, vacations or illness vacancies.  There isn’t a line up of qualified applicants for these remote sites reachable by air only.  If the need is in Aleutians we are happy to return.

 On off time we work on our house and travel.  We are not sailing now; we fly.  In the spring our plan is to fly across country in our company Cessna 172 to do research in Plymouth for my book about the Pilgrims, and also visit the new grandbaby and proud parents.  I am a student pilot.  Bob is an experienced pilot.  Then a six week visit to the British Isles and Ireland to continue research on the other side of the ocean, where the Pilgrims came from.   We will  look it over for OTG Adventures Inc., our small personal travel company too.  Our trips with tourists to Kenya for wildlife safaris have slowed down since the terrorists have sped up.   Instead of Africa for guided trips, perhaps Maine our original stomping grounds or Alaska or  perhaps Italy.   It is a big beautiful world. 

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