Monday, March 9, 2009

Adventures in Hooper Bay

"On August 3, 2006, a fire destroyed approximately fifteen acres of the city before being extinguished. Destroyed in the blaze were thirty-five structures, including twelve homes, an elementary school, a high school, a teacher housing complex, stores, offices and storage shelters. The fire left 70 people homeless, most of whom have stayed in Hooper Bay with friends and family."
ABC Alaska News. Aug 4, 2006

It wasn't long after lunch that I heard one of the ER technicians calling my name.
"Jess! Jess! They're going to Hooper Bay and they want you with them!" she said, half-running down the hallway.
"Now?" I asked, setting down the chart I was reviewing.
"Oh yeah," she said. I made my way back to the pharmacy, threw on my snow-boots (the very ones that had earned me the nickname "Anti-Grav," my snow pants, and parka. I caught a cab to the Ptarmigan hangar where the LifeMed planes leave. This time, I beat the paramedics there. The door front door was locked so I went around to the side entrance, which I knew would be left unlocked.

The weather had been hovering in the 30's for some time, making some areas very wet. Thankfully, the snow had insulated the majority of the ice underneath, keeping it frozen. Unfortunately for me, the large metal hangar had been reflecting the sun back on to the snow all morning and as I traversed across the snow, I felt my left boot break through the ice. I looked down in shock, seeing a bluish slurry surrounding my left leg. The temperature of my leg immediately began to change. I pulled my boot out, fighting the suction. I looked up toward the door. I was nearly exactly half way--if I continued, I risked plunging into the water again, perhaps this time much deeper. If I returned the way I'd come, I could easily crack through the ice I knew I'd weakened from walking on it the first time. I knew there was a wooden platform hidden somewhere under the snow just outside the door. The choice was simple--I had to go through this door and there was no turning back. I knew if I took another step I'd plunge into the ice. I made up my mind and took a giant leap for the platform I hoped was there.

I was right. My boots flattened the snow and I heard the "thunk!" of wood underneath me. I breathed a sigh of relief and pulled open the door. The Cessna 170 sat in the hangar. The pilot came around the corner. He was a different pilot than my last flight. I introduced myself. He asked for help and I jumped on the towing rig, helping watch the corners as we towed the plane out of the hangar and on to the tarmac. Soon the LifeMed EMTs arrived and we were on our way. I sat with the pilot again and was given a crash course in VOR navigation.

"Hopefully I'll be getting my license one day and can use this stuff," I said to him over the radio.
"Who knows, you might need it before then," he said. I gave him a questioning glance. "Haven't been feeling good," he joked.

Since the topic of safety had come up, I asked him how the weather impacted the EMT flights, comparatively. He explained that when the weather was really rough, they would take the Blackhawk helicopter. If it was dangerous--the patient would have to wait, hopefully being kept stable by the limited staff at the clinics. "Sometimes," he said, "the wind will be so strong you'll turn into a windmill on the runway. The tail catches the wind and no matter how hard you fight it, you start doing 360's while you're sitting on the runway. We've had to do a lot of repairs from that. One guy a month ago had his plane flipped over." I asked if they ever had difficulties landing or taking off. "Oh yeah," he said, seriously, "all the time....all the time...."

Out the window, the barren tundra lay undisturbed. I wondered when the last time a human had walked on the square mile below me. We passed over a hundred miles of tundra, with winding rivers making their way toward the Bering Sea. Occasional patches of forest blotted the landscape. I scanned for moose and caribou until the forests disappeared. A looming shape appeared on the horizon. It was some time before I realized it wasn't a cloud formation but mountains. I wasn't sure if I was simply unaccustomed to seeing mountains or these mountains were particularly tall; they seemed to reach far above the 10,000 feet we were flying at and ended forcefully at the ocean. I wondered how far below the water the slope downward continued. Anyone hoping to answer that question would currently have to chip through the sea ice to find out, however. Not something I was keen on signing up for.

The sea ice stretched out as far as I could see, 30 ft tall chunks jutting upward, making the entire landscape appear sharp and mottled. The Hooper Bay runway ran parallel with the water. I could see the town of Hooper Bay in the distance--we'd definitely be needing some kind of transport to cross the distance efficiently. We landed without trouble. Nearly immediately after, a snowmobile carrying a makeshift sled raced up. We loaded our gear in it and hopped inside. This wasn't like the well-made dogsled I'd ridden in before--this was put together with composite board, a few nails, and was in desperate need of repair. Bracing myself on top of the Pepsi cases we were sharing the cargo space with, the sled began to race toward the town. I watched the snow whip by on either side. The ground was uneven; every time we hit a bump, a spray of snow covered me, temporarily blinding me until I wiped it from my eyes. It was much colder here than in Bethel. The wind hitting my face was extremely painful.

Struggling to minimize my exposure to the wind, I turned. As I did so, my back lightly pushed on the back of the sled. I felt the board supporting my upper back give way without warning. I grabbed the side of the sled and a handle from a Pepsi crate, turning my head in time to see the board I'd just been relying for support break off of the sled and tumble away behind us, quickly disappearing as we shot toward the village at nearly 35mph.

We soon approached the village. Again, the residents waved to us. The driver pulled the snow machine over small bridges and pulled up to the clinic. We jumped out and were soon treating the patient, who was in respiratory distress. The decision was made to transport them back to YKHC. We bundled them up in defence against the cold they'd soon be facing and made our way back out to the sled. But the sled had been moved. At some point during our treatment, the decision had been made to deliver the Pepsi. "We need another sled. Start asking!" the medic said to me. I soon found a family willing to take us back to the plane. We loaded the patient into the sled. There was only room for one on the sled. I glanced around. One of the patient's family members stood up. "Jump on mine," she said in Yupik. "I'll take you." I jumped on the back of the snowmobile and grabbed on just in time before she hit the accelerator, racing after the sled. "We've got to catch up," she said, this time in English. "Okay to go fast?"
"Sure," I said. I'd barely gotten the word out before I heard the engine rev. We flew over the humps in the snow, landing hard and lurching forward again, ready for the next one. The sled in front of us grew closer and closer. Just catching up with the sled apparently wasn't on the agenda. We flew by it and sped up even faster once we we in front. Soon, we skidded to a halt next to the plane. "Quyana," I said, saying thank you. She nodded and began her trip back. I prepped the plane and had it ready for the patient by the time they arrived. We hoisted them into the plane on the stretcher and I started the IV fluids before climbing into the co-pilot's seat again. We took off and made our way back. I tried to take in the scenery, knowing it wouldn't be long before I was away from this place. On arrival back at the hospital, I thanked the EMTs and helped make sure the patient was situated in the ER, recalling the gist of the chart to the physician on duty.

Though the day had been long, I enjoyed my time at Hooper Bay. The city had been quiet, nestled at the base of the mountains next to the ocean, and had a sense of tranquility about it. I imagined the town during the summer nights, the night sky unobstructed by light pollution. Being so close to the Bering Sea, marine life is bountiful in Hooper Bay. One day, I'd like to go back. Rumor has it they are building a new clinic and will need a pharmacist.

Tuesday, February 24, 2009

Best in Snow

Sunday was the 5th annual Bethel dog show. The town seemed abuzz with some kind of hidden energy. Eric and I had journeyed into down so he could purchase groceries at A&C, one of the two grocery stores in town. We had wandered the isles for some time, evaluating the choices that had so much financial implications. I kept my distance from Eric as he took photos of the prices. At the end, he eyed the cache.

"Think we can do it, or should we call a cab?" he asked. The hospital had given us $5 cab vouchers. The cab companies were subsidized by the government, so any ride in town cost only $5 per person, no gratuity required. However, we were running low on vouchers, and were thus conserving our trips. The grocery store was a little over a mile away, so it seemed relatively manageable on this relatively calm day. We decided to walk. Eric filled his rucksack with the heaviest of goods and we split the rest. On the way back, we passed a man, possibly a YK employee) chipping away the ice on the boardwalk.

"Dog show's today," he said as we passed. I'd been hearing about it for some time. I was told it was quite the spectacle. On the way home, Eric stopped to take a few pictures of some graffiti on a dumpster.

Eric taking a few photos of the dumpster.

When we finally arrived back at the house, our arms were exhausted from carrying the goods and running short on time before the dog show. We needed to get there quickly, and so, shaking our heads from our lack of planning, we called a cab. Instead of using the cab vouchers to help us carry the groceries from the trip back, we'd use it to go just half the distance carrying nothing.

The dog show was entertaining. I was surprised to find the cultural center packed with people. I found a seat in the back row next to Mark, the LifeMed medic. Before long, there were no seats left--people began lining the walls. Dogs barked from backstage. There were numerous categories, including toys, working dogs, and sporting dogs. Also included were categories such as "Best Tail Wag," "Best Trick," "Best costume," "Most Independent," and "Most Obediant." Of the latter, there were no entries.

Bethel residents brought out their dogs, marched them around the room, and lined up. The panel of judges (who received much applause on their entry) stood alert and appeared studious with their clipboards. Typically there were five or six dogs in every category. Aside from two pure bred pitbulls, a black lab, and a pure bred huskey, the "Bethel breed" dominated the population, the star being a huskey dauchsund-mix. The audience clapped their hands enthusiastically for the winners, roared with laughter when dogs escaped their collars and found more interesting things to do than perform, and took plenty of pictures. The winners came away with tiny trophies, dog biscuits, and medals. Everyone--winners, losers, and audience members, left smiling, waving and hugging each other goodbye after the event. It was another example of a small community coming together to create an event that was simply pure fun.

Sunday, February 22, 2009

Pharmacist vs Wild

-- Yup'ik word, meaning "to be persistent when faced with difficulty."

I spent the morning seeing pediatric patients with Beverly Burden, who had graciously taken me under her wing for the morning. I enjoyed working with kids and found them easy to provide for, as long as I wasn't about to inject them with something. The YK region (about the size of the state of Oregon) sees a lot of skin infections, primarily MRSA, and thus I'd seen plenty of mupirocin and hydrocortisone topical agents being prescribed. I was reviewing a chart when Beverly ran in.

"LifeMed's getting ready to fly," she said. "They're taking off in half an hour--if you're not there, they will leave you." I thanked her and darted to the pharmacy for my coat. LifeMed was essentially the YK ambulance for outside of Bethel. Should an outlying village need help, LifeMed was ready to dispatch its paramedics and transport the patient back to the hospital if needed. I raced over to my coat, threw it on, and explained hurriedly to the pharmacists where I was going. Soon I found myself in a taxicab on the way to the airport. I was unsure where the medical hangar was and thought for sure the experienced Bethel cab driver would know. However, he had no idea. After finding every hangar except the medical hangar (including the National Guard hangar) we stopped to ask the cargo flight crew where the med hanger was. I was sure I was going to miss the flight, but after asking the cargo crew, they pointed to the big white building next door. I gave my cab driver two vouchers and ran across the ice to the medical hangar.
The EMTs were getting ready and ushered me through the door. We made our hurried introductions as we jumped on to a Cessna 280. There was Mark and Mariso, the EMTs, and Taka, the pilot. The plane was loaded with the usual emergency equipment, stretchers, hypothermia gear, etc.
"We can do basically anything in the field," Mariso explained to me. "We're given a great deal of liberty since we might be hours away." He showed me their pharmaceutic pack. It was filled with drugs from nearly every class. Since it might be hours (or days, if they were delayed by weather) before the patient would see the hospital, they were equipped to stabilize and begin managing nearly every medical emergency. I asked where we'd be going.

"Kotlik," he said. He handed me a copy of the flight plan. Kotlik was a small village on the Yukon River with thirty to fifty buildings, a small airstrip, and not much else, up in the very Northern corner of the area YK served. It was about 154 nautical miles from Bethel.

We took off and flew at approximately 4,200 ft, traveling at about 160 knots. The trip took about an hour. Underneath us, I watched the barren Alaskan tundra roll by. Not a tree, shrub, or moose speckled the perfectly snow-painted ground. Tiny frozen rivers weaved in an out, flowing to and from the small lakes. Presently we passed over sparse forests and I wondered when the last time, if ever, that a human had walked on the land beneath me. I was now further North than I had ever been before in my entire life.

View of some Tundra on the way to Kotlik.

Blinded on the way back to Bethel.

We arrived in Kotlik and loaded up a handmade dog sled with gear, climbed on, and rode into the village, powered not by canine mechanism, but by snow-machine. It pulled us over the small ridges and around corners fast enough to make the 18 degree temperature feel much more like -20. I braced down the equipment. "You'll have to tell your pharmacy buddies about this one," Mark said, riding on the back of the sled, where the musher would. "I bet they all wouldn't do this." We hit a large bump, sending myself and the gear a foot into the air. I landed hard back down on the wooden sled. I pictured some of my fellow students doing this and figured Mark was probably right.

We past several dozen small buildings, each supported above the permafrost on pillars just like in Bethel. But where the buildings in Bethel were relatively well maintained, there were several buildings in Kotlik in desperate need of repair. Aluminum siding was braced against the sides of many buildings, not unlike some of the village housing I'd seen while in Fiji. Snow covered everything. A husky gave us a few welcome barks from on top of a large stump. Several people were walking around, looking toward us as we passed by, our nylon parkas, brightly colored bags, and sense of urgency contrasting greatly with the environment around us.

On arrival, we stabilized the patient and began our return to the airport. The people of Kotlik were kind. The kids were listening to iPods. I would have liked to explore more, but we were obviously not there to sight-see. I jumped up in the co-pilots seat for the flight back. The sun penetrated the windshield easily. The sky was perfectly clear, making it easy to the ground. I wished I had my favorite sunglasses, since I spent the hour and a half-flight back squinting.

I imagined myself in a different situation--as the patient in a village who had to have the village call the EMS after an accident. I would wait for hours before they arrived. The weather, unlike today, wouldn't be the ideal, perfect visibility conditions, but one of the frequent torrential blizzards, which would delay the return to the hospital. The pilot, constantly having a plan B, or C, would turn the plane around to a safe place to land, but the EMTs would have only so many resources available to them. For some people, this is a very real situation.

Then why live out here? Why live in the middle of nowhere, without running water, away from help, where one must trap, attempt to farm, and fish to guarantee survival. The answer I obvious to the people who do this. They do it because that is who they are, and that is how it has been done. This kind of continuous survival has instilled a kind of genuineness that is so easily lost with convenience. It is something to learn from, and during my last bit of time here, I plan to soak it in as much as I can.

Wednesday, February 18, 2009

Fast Change

When the temperature drops so fast like that, it means someone has died or is dying on the tundra. Just today a man was reported missing from one of the villages. --Roxanne, Behavioral Health Clinic, Bethel, AK

Where yesterday was easily negative thirty without windchill (they're saying it was -50 with), today the temperature has again shot back upwards to near 30. I had heard it raining last night for the first time since my arrival in Bethel and awoke to find everything coated in 1/8" of dense ice. I half walked, half sailed my way to the hospital this morning, hearing the thin layer of ice on the snow shatter under my feet with every step. I didn't find the temperature change annoying--more amusing, since I'd never experienced a sixty-degree temperature change in fourteen hours.

The wind and rain didn't really come across well in this video, but I thought I'd experiment and post it anyway.

With Eric's persistence motivating me, I had called the internet provider up here to see if we were supposed to have service. They claimed we were, and sent someone out yesterday to repair it. It's not a fast connection, yet it is faster than at the hospital, so I'm hoping to be able to upload things easier. At any rate, I should at least have more opportunities to get online, which will make email, my PharmD project, and general communication much easier.

Tuesday, February 17, 2009

Will Wander for Experience

"When I was a kid, we were somewhat nomadic," she related. "We went to fish camp, we had a summer and a fall camp and a winter camp, and we traveled far. We also had a permanent home in Bethel. Respectfully, traditional people were taught to leave camp areas better than they found them. There is no evidence at all of my family ever being in those places, because my dad kept the camps up well. Life seemed very carefree and peaceful then."
-- Yup'ik Mary Stachelrodt in Lowry's Natives of the Far North

I recovered slowly, but more or less fully from the "Bethel Crud," and had been looking forward to my three day weekend. Saturday morning I woke and hopped in a cab to watch the Bethel Shotokan Karate Club practice.

I arrived in time to see a fairly large group of kids finishing up their practice, practicing Heian Shodan. The kids practice was before the adult practice. I was pleased to hear them counting in Japanese and watched as a few kids practiced with very focused expressions. Soon the practice concluded and the instructor came to greet me. He introduced himself as Ted Berry and talked a little about their practice. They were part of the International Shotokan Karate Federation, a branch of the JKA, which had split from the SKA, the organization to which I belonged, several years ago. I watched the adults (and older kids) practiced and although the practice was different from my own, it felt like home hearing the kata being announced, the cry of "hajime!", and the sound of over a dozen karateka kiai in the dojo space.

There were significant differences as well--the movements were very diliberate, almost as if each kata were being counted by the movement instead of the kata as a whole, they "popped," making their gi snap with each movement (though not as much as some JKA karateka I'd seen), and they waited for the instructor to announce before they began their attacks in kumite. I had seen these differences before in karateka coming to practice with our SKA group. I was invited to attend Monday's practice and did so. I enjoyed the kata practice. Ted came up to me and said "I notice you don't wait very long in between movements," as a general observation, which was undoubtedly correct, comparatively. I knew that sometimes I had the tendency to short-change movements for the benefit of continuous feeling throughout the kata and took the opportunity to attempt to make each technique correctly. It was a fun practice with kind people.

My new roommate, Eric, arrived on Sunday. A pharmacist currently living in Seattle, he had spent some time in Anchorage and signed up for a 2 month stint in Bethel at YKHC. He enjoyed photography, and within an hour of his arrival had removed his camera equipment and was educating me on "camera tossing" and "water world," two new methods he was interested in. Camera tossing is done at night, where a neon sign is the target of the shot, the shutter is opened for a second or so, and the camera is tossed in the air, so that the result is a swirls of color. That night, he practiced taking "water world shots," using a glass illuminated by a light in a dark room, taking pictures of the ripples and patterns the light made. He maintains a website of his photography as well. He seemed like a nice guy and I anticipated a pleasant two weeks with him.

Sunday night one of the pharmacists, Greg, picked me up and took me to his home to show me some of the processing that occurs after an animal is trapped. It's been a record year for Greg, trapping a total of 17 lynx, 2 wolves (with the help of his partner), plenty of fox, and a handful of mink. Compared to the lower 48, he explained, much of Alaska was virtually overrun with wildlife. He insists trapping has not had a negative effect on the population as a whole. Regardless, I was interested in the cultural learning opportunity ahead of me and proceeded to help him skin a lynx, which definitely goes down in the books as something I didn't think I'd be doing on my clinical rotations.

He and his family welcomed me to stay for dinner, where we had a Korean dish made with caribou. It was tasty. I drove Greg's Durango back to the "prison row" housing, which was somewhat daunting considering it was snowing a thick, wet snow, the roads were slick, I was in a vehicle I'd never driven before, in a town I'd never driven in, and was without any form of identification. But I made it back without incident, left the keys in the ignition for him to pick up the next morning, made sure the doors were unlocked and went in to go to sleep.

Monday the temperature dipped from the low 30's to the negative teens. A howling, 45mph wind had picked up during the night and had frozen Greg's doors shut, effectively locking his keys in the car. After some struggling, we managed to get it open using some boiling water along the seam of the door. Mandy showed up and we attempted to enter one of the respiratory therapist's house to get her birth certificate, which she'd left by accident before leaving to Anchorage. We were unsuccessful. Security here, it seems, is pretty tight.

This morning the temperature fell to -27 with 5mph winds. It will make for a good trip when I wander over to behavioral health to round with a nurse practitioner there.

Friday, February 13, 2009

When Providers Become Patients

"Everybody was healthy then. Gee, we'd come down from spring camp in the hills and we'd get to Akiak and we'd look at the people who stayed in Akiak and they'd look pale. I asked one of my uncles if he was sick all spring. 'Nope,' he said. All the rest of us were sunburned and weather-beaten--healthy."
--Carl Kawagley, Bethel, Alaska

Respiratory issues are not uncommon, particularly in cold areas. Frostbite doesn't just occur outside the body. When the temperature drops low enough and the conditions are right, the tiny alveoli in the lungs can freeze, leading to infection, COPD, and other respiratory issues. I'd seen a few cases of it since I had arrived in Bethel.

Of course, one of the potential problems with traveling to a far away place is first time exposure to new pathogens. This barrage of primarily cold virions leads to what has been called "The Bethel Crud." I was not surprised when I started showing minor cold symptoms several days after arriving, but I rapidly improved to a near base-line condition as the days progressed.

Until several days ago, when I had suddenly found myself feeling very sore, weak, and cold. I didn't have a thermometer available at the house I was staying in, but shivering in an environment that is room temperature is a sign the body is trying to increase its temperature more than normal. I bundled up and crawled in to bed, hoping the soreness would subside by morning, as I knew it would be a busy day.

I didn't have to wait until morning to wake up. At 02:12, I found myself tossing and turning, sore, and feeling very feverish. After a few minutes of struggling, I pushed the blankets off, crawled out of bed, and stood up--and nearly fell over. Bracing myself against the wall, I assessed what was going on. Difficulty forming thoughts. Not entirely unusual, but something seemed amiss. Sweating, yet freezing. That was definitely unusual. I hurt all over. Had I been in an accident? No. Did I just return from a hard practice or was I recently knocked unconscious during kumite? No. Definitely unusual. Head pounding. I rarely get headaches. Any new medicines? No. Sign and symptom identified: FEVER. Letting a fever run for a while isn't necessarily a bad idea in some cases, but since I was having obvious nervous system impairment, I decided it was time to halt the process my body had deemed necessary.

Leaving my primary diagnosis undiagnosed for the moment, I found my way to the cupboard and removed a bottle of tylenol that had been stashed there. I wondered which temporary clinician had brought and left it--had it been one of my fellow pharmacy students? I wasn't sure, but I took 1000mg and gulped a glass of cool water, sitting myself down on the couch. It was definitely difficult to think, uncomfortable to move (or sit still), and my head throbbed. I dipped my finger in the water glass and ran it around my neck, feeling the evaporation cool my body. I sat there for an hour, tried to read Pharmacy Times, found it impossible, and resulted to watching bad late night TV. An hour and fifteen minutes later the symptoms had diminished somewhat, but where not completely gone. Okay, I thought. Plan B time. I pushed myself up, turned the shower to cold, and hopped in. I alternated between warm and cold water until I felt the fever had broken, and got out of the shower. I toweled off, felt better but not great, and went back to bed.

The next morning I felt like my head was heavy but made it in to work. As the day progressed, I became more symptomatic--headache demanded I acquire some of my preceptor's tylenol.

"There's both acetaminophen and ibuprofen," she said, handing me a bottle. "It's all in the same one." I stared at the bottle. Tylenol and ibuprofen both in the same tablet? I was having trouble thinking straight again.

"What, together?" I asked. She looked up at me and shook her head. I popped open the bottle and clearly saw two different kinds of tablets, a pharmacy faux pas. "Oh. Together as in you put them both in the same bottle." She asked if I was going to make it and I assured her I would.

Later that day I decided to go home early and rest. I felt more rested the next day, but my symptoms had not improved. I increased my hand washing regimen to its highest alert status to ensure I wouldn't contaminate anyone while on rounds. My voice quickly degraded, until I was barely squeaking. I soon began a non-speaking role. At the end, a physician asked me why I hadn't gotten antibiotics and for the first time, I took the time to put all the pieces together:

Fever. Headache. Pressure on sinuses. Heaviness, especially when leaning forward. Phlegm, color: greenish. Post nasal drip.

Probable diagnosis: Bacterial sinusitis
Practical Treatment: Augmentin 875mg/125mg 1 PO Q12H x 10 days

I found myself creating a chart (with the help of the people up at reception) and soon picked up my prescription, where Steve, a pharmacist with a sense of humor, had thought it funny to place the "Antibiotics may decrease the effectiveness of oral contraceptives. Use an alternate form of contraception." sticker on the bottle.

Though my voice hasn't totally returned, I am finding myself feeling much better and plan to be tip-top on Tuesday. I'm reminded how easily it is for care providers to let themselves go untreated. It was interesting to see myself "in the system" at YK and to have a reminder to look at things from the patient perspective.

This weekend is the open market, which I am going to attend after watching a local karate club practice.

Monday, February 9, 2009

Alaska Has the Greatest Number of People Walking To Work

"When we hunted by kayaks we went in pairs, two boats together, but many boats going out. Sometimes we would catch five seals, put them in the kayaks and paddle back to camp with the kayak very low. Water almost over the deck. Slow paddling! After seal hunting and the drying of the herring, in the middle of the summer, we'd move back to the village. And then, get wood, driftwood for heat. All the time coming and going. I could paddle for many hours and not even get tired."
---Dick Lawrence, Toksook Bay elder, excerpt Always Getting Ready

My first weekend in Bethel was relaxing. The temperature dropped back down to it's normal twenty below-zero, calming the land like a giant atmospheric blanket. The one exception to this seemed to be my roommate, Erik, who was busy triple-checking his luggage. He would leave that afternoon.
Though the temperature might have dipped into it's normal range, the wind had picked up, sending great swirls of snow into the air, bending the shrubs outside and testing the aeronautical ability of the raven, a life form that seems to be able to subsist anywhere--the arctic tundra no exception. Erik looked nervously out the window, no doubt wondering whether or not an airplane could take off in the weather. I suggested the impossible notion our weather was due to Mt. Redoubts eruption, making him cringe. He had been keeping himself updated on the volcano's status for some time, but it had remained the same: possible eruption, time frame unknown, severity unknown. As the morning progressed he became more anxious. When one o'clock came, he had his bags ready to go, wheeling them out the door at almost the same instant I opened it for Mandy, who was taking him to the airport. He shook my hand, and with that, he left Bethel.
Or not quite. For apparently, when he arrived at the airport, the visibility was too bad for a Alaska-inexperienced pilot to try to land. The plane had turned around before it had arrived. He spent some time exploring his options instead of simply waiting for the next flight, even inquiring the possibility of chartering his own. Mandy had left the airport after waiting for him for some time. Erik never returned to the shack we had shared for the week. And so, based on that evidence, he eventually made his way out of Bethel, AK.
I spent the morning cleaning up the small house. Due to it's frequency of temporary tenants, very little had ever been done to ensure a hygienic environment. The material I removed from the bathroom could have made a biohazardous waste employee stagger in shock. After I had upgraded the building's status from "Fallout Zone: Do Not Enter" to "Rehabilitation Area: Proceed With Caution," I set about doing some projects for the day until the evening.
That evening I had planned to go with Beth and Alexis, both pharmacists, to see the Bethel Actor's Guild presentation of The Wizard of Oz, in which Mandy was assigned to be the accompanist and projected several of my other fellow health care workers in various roles in the story. For the $20 admission price, you might expect ushers, stadium seating, and the like, but the performance was held in the Cultural Center, on a staged pieced together with angled platforms and boasting padded folding chairs for the audience. Though by itself it wasn't a fantastic performance, there were a few excellent actors tossed in the mix, the largest value of it being the ability to see one of the recreational options available to the people who lived here. In the end, Toto growled at everyone, the wicked witch had a perfect laugh, and Dorothy delivered all her "oh!"s and "oh my!"s to a T, and was worth the $20.
That evening I made my way to another shack on "prison row" to hang out with some of the other health workers, listened to stories, and learned some interesting things about the town. The next day, I decided to walk into town and buy some more paper towels (I had ran out relatively early in the sanitation work the day before) and a few other necessities. I made my way down and passed raised building after raised building. Upon reaching my destination, I found several chunks of ice frozen to my eyelashes, eyebrows, and unshaven face, despite much of it being covered up.

Travel is an important part of life for the people here. Whether or not one lives in an outlying village or not, long distances are traveled both on foot and by vehicle. People so elderly most Americans would be surprised to see them standing are frequently walking miles to do basic tasks. It is a hunting/gathering/nomadic culture, and no one seems to complain. I do think, however, that the majority of people would never expect the kinds of conditions that exist here to be present in the US, much less North America. I found this to be highlighted, to my surprise, on CNN today:
It is, without a doubt, a completely different culture, and a valuable one to see. Greg, a pharmacist, stopped by not long ago and delivered the news I'd be traveling to one of the villages on Wednesday to investigate the mysterious disappearance of narcotics from a clinic there. We'll see what happens.