When the High Temp of the Day is -16 Degrees

We're back to our regular winter programming, with sparkly snow and that familiar sub-zero chill that makes it difficult to be outdoors for more than 15 minutes at a time before your fingers, toes and nose start feeling mildly frostbitten.  I spent  part of the weekend working in the ED, where I ran my own little fast track section for visits that really weren't emergencies at all: sore throat, cough, pinkeye, oral thrush, STD scare.  The ED clinicians use a nifty prescription medication dispensing machine after hours when the outpatient pharmacy is closed.  The genius dispenser looks almost exactly like this candy vending machine:

You order the prescription medication of your choice (nystatin suspension, azithromycin, triamcinolone, etc) on the computer.  A prescription label is printed out, and the nurse puts in a password that allows the machine to release the medication so it can be labeled and given to the patient.  Sometimes the medication gets stuck and you have to bang on the dispenser and yell at it a little, like a real live vending machine.

Knit 1, Purl 2

Friends, a true miracle has occurred:  I have actually taught myself to knit by reading a book.  It is very difficult to learn a complex 3-dimensional procedure by interpreting words & photographs from a 2-dimensional page, but it has somehow happened.   True, I'm still using acrylic practice yarn, my cables get a little jacked up, and every now and then I accidentally add or lose a stitch, but I am now my very own one-woman sweatshop.  Would anyone like to place an order for a hat, scarf, or (if I'm feeling ambitious) mittens?  Specify size, color and yarn type. Anyone...?  Otherwise, it's going to be a very loooong winter (and as Jerry Lewis says, idle feet are the devil's toenails!)

Aftermath

During the day, it continues to rain; then at night the temperature drops and ice starts to form.  There has been so much rain that water is accumulating on some roadways.  Most parking lots are a messy amalgam of slush, ice, and puddles the size of small ponds:

The Fairbanks North Borough superintendent finally decided to close all the schools late yesterday morning, after 5 school buses slid off the road and got stuck in ditches.  Apparently the children of Fairbanks haven't missed a school day since 2003 when there was a massive ice storm.  

The clinic is still open for acute appointments.  Who is risking life & limb to seek medical treatment in such hazardous driving conditions?  A mother bringing her 2-1/2 yr-old daughter in for vaccinations & a well child check that was due at 18 months.  A 19-yr-old woman with an acne break out, 3 weeks away from her wedding.  A 27-year-old woman who wants her IUD removed "because my husband says he can feel the IUD" with his ultra-sensitive penis during intercourse "and the IUD strings are poking inside his pee hole".  Don't get me started on how this is utterly physically impossible because the IUD is in the uterus and the penis can't go through the cervix into the uterus, and how even a board-certified urologist would have trouble getting the soft paragard IUD strings to thread through the penile urethra.

Freezing Rain

Freezing rain doesn't actually fall from the sky in an already-frozen state.  Raindrops are super-cooled while passing through a layer of gelid air just hundreds of feet above the surface, then freeze on impact after falling, forming a thin ice glaze as multiple drops accumulate.  This makes for hazardous driving conditions.  Today's unseasonably warm weather (low 30s) is rare; the last time Fairbanks had rainfall instead of snowfall in November was in 1936!

My car this morning was enveloped entirely in an opaque ice glaze accented with indentations formed by continuous pelting from raindrops.  It looked like an avant garde glass sculpture.  The temperature was hovering at just below freezing as I gingerly pulled the car out of the parking lot and started the treacherous commute to work.  The roads were extremely slippery, as if someone had gone over every inch with a Zamboni.  I'm pretty sure I was driving more slowly than all your grandmothers combined.  The walkway in front of the hospital might as well have been a skating rink; several of us slipped and nearly fell more than once.  I really should have worn ice skates to work.

Museum of the North

When I was a kid, my father enjoyed recounting tales of his own childhood fortitude.  "When I was your age," he would say, leaning back in his chair, "I walked [insert ridiculous # of miles] to school in the wintertime".  Well, Dad, today I walked 4 miles through a pseudo-blizzard for a round trip from my apartment to the University of Alaska, just so I could visit the Museum of the North.

The Fairbanks campus, established in 1917, was the first branch of the University of Alaska.  World-reknowned research is conducted here in the fields of Arctic biology, Arctic engineering, geophysics, supercomputing and aboriginal studies. The Museum of the North is located on the aptly-named Yukon Drive, and the snow was piling up rapidly as I approached the building:

It's a bit of an architectural wonder, with its asymmetrical shaping and specialized climate-control exhibition areas that house 1.4 million artifacts and specimens:

I especially enjoyed the exhibit on Alaskan Native crafts which displayed astoundingly intricate beadwork in the form of collars, bibs, pouches, and slippers:

I would totally wear this Yup'ik dance headdress (made from cloth, felt, seed beads and wolf & wolverine fur) and even these Yup'ik men's dancing gloves (made from leather, sealskin, seal fur and sinew):

 

There was a wonderful display of spirit masks (with part human/part animal faces, worn during ceremonial dances as an appeal to the spirit of prey animals) made from a variety of materials.  The one on the right is an Inupiat (King Island) maskette made from walrus ivory, mammoth ivory, baleen and feathers:

And there were delicate patterned baskets woven from grass, and a wonderful display on the ulu (an Inuit all-purpose knife traditionally used by women) made from steel, copper, brass and bone and used for skinning & cleaning animals, chopping food, cutting children's hair, and trimming blocks of snow and ice for igloo-building:

I could certainly use an ulu right now, to give myself a much- needed haircut...

The Crazies Are Coming Out of the Woodwork

A 55-yr-old woman tells me she was sitting in church on Sunday when she suddenly felt pain and "chills in my vagina".  I'm not sure what she means, and she doesn't know either.  All she knows is that her "pee smells bad".  Ironically, she is wearing a gallon of cologne and the fumes are making me woozy.  I quickly perform a pelvic exam before her cologne knocks me out completely, and there is nothing out of the ordinary.  Her wet mount, KOH prep, urinalysis, and cervical swab for chlamydia & gonorrhea are all stone cold normal.  Maybe having chills in your vagina is not such a terrible thing after all.

A waif-ish 32-yr-old woman comes in and spends 20 minutes complaining about frequent headaches that don't respond to ibuprofen.  She is vague about her symptoms, and all the medications I mention (triptans, beta-blockers, neuroleptics) she thinks she's already tried without relief.  She doesn't have medical records from her former neurologist.  "I had percocet once," she says coyly, "and it was too strong."  She asks for tylenol #3 (with codeine), "just until my medical records arrive."  Against my better judgment, I give her a limited prescription for 10 tablets with no refills.  Two hours later, she returns to clinic pouting, led by her grim-faced husband who is dressed in army fatigues and combat boots.  Turns out she's been in & out of treatment for an addiction to prescription narcotics & benzos for the past 4 years, but none of this is in her medical chart.  Needless to say, she'll be returning to treatment as soon as possible.

Sometimes I get a more satisfying case that makes up for the crazies, like the 10-yr-old girl with recurring muscle spasms in her left trapezius.  She had been seen in February and given a trigger point injection which provided good relief for several months.  She had full range of motion and normal strength in her shoulders & arms, but I was disturbed by a subtle asymmetry: her left shoulder was slightly higher than her right; and her left scapula was just a hair more prominent than the right.  She had been told that this was due to "stress".  I ordered a series of plain films which revealed mild scoliosis manifested by a teeny 11.9 degree levocurvature of her thoracic spine.

I wonder if I'll ever get used to having 20-minute appointment slots. It rarely ever seems like adequate time to spend with each patient, especially when it also encompasses the time it takes for the medical assistant to call the patient from the waiting room, take vital signs, and review allergies and medications.  By the time the patient is ready to be seen,  I'm lucky if there are 7 minutes left in the appointment slot.  It only works if it's a relatively straightforward medical problem, or if the patient can give an awesomely concise synopsis: "I'm a 19-yr-old G0P0 with a history of chlamydia, continuing to have unprotected sex, here for evaluation of crampy low abdominal pain with unusual vaginal discharge, s/p an exploratory laparotomy for what turned out to be severe pelvic inflammatory disease with Fitz-Hugh-Curtis syndrome 3 months ago"...[I really did see that patient!  But without the neat synopsis]

The Acronyms Are Driving Me Crazy

Every day I get memos in my military email account peppered with acronyms I'm not familiar with.  DMHRSi?  NCOIC?  TCON? ERD? I need some sort of acronym secret decoder ring to understand my email memos.  Even the faucet handles at the clinic are etched with acronyms: HW for hot water, CW for cold water:

Sub-Zero

Like clockwork, now that it's mid-November, sub-zero weather has arrived in Fairbanks.  Tonight the temperature dips down to -5, and tomorrow we have -20 degrees to look forward to.
How long does it take hot water splashed onto the windshield to freeze?  Less than two seconds.  Not. Kidding.
Ice fog: Fact or Fiction?  Ice fog develops when warm water vapor (from car exhaust, exhaled breath, etc) meets super-cold air, causing microscopic ice crystals to form in the air.  The frigid air can't absorb these ice crystals which congregate to form a dense cloud.  When it dips down to -30 degrees, I'll be sure to run outside just to exhale and watch my breath form a tiny cloud of ice fog that doesn't dissipate.
Does wet hair freeze when you go outdoors in sub-zero weather? I'm not brave enough to perform this experiment.
How short are the days? Today we had 6 hours 16 minutes of daylight, and each day gets progressively condensed by 7 minutes.  By winter solstice on December 21, daylight will only last for 3 hours 42 minutes [Please, sir, may I have more vitamin D?]

The Land of Aurora Borealis

It was an All-Asian night at the Aurora Borealis Lodge: just me, two visitors from Los Angeles, two from San Francisco, and our affable host Mok & his family.  The Lodge is 20 miles north of Fairbanks, on Cleary Summit (elevation 2000 ft), on a hill overlooking a beautiful forest, with a spacious viewing deck facing northward.  When we arrived at 10:30 pm, the sky was already glimmering with faint patches of aurora radiating modestly.  Over the course of the next 3-1/2 hours, we experienced an astounding display of auroral forms.  I've seen photographs of the northern lights, but still images can't convey the amazing dynamic nature of the phenomenon.  The greenish-white light morphed from a swirling plume to a billowing tower to a glowing arc across the sky, then back to faint patches with tiny delicate rays.  The light appeared white when viewed with the naked eye, but it took on a phosphorescent greenish hue when photographed at high shutter speed with a 10-second exposure.  My low-tech camera couldn't capture the images properly; I was envious of the overnight guests from Japan who had scurried out from their accommodations armed with tripods and SLR cameras with wide-angle lenses.  Here's a series of aurora borealis video clips that I cribbed from the University of Alaska museum:

The aurora borealis is best viewed on clear nights with minimal moonlight when the level of geomagnetic activity is elevated.  Activity is measured by the Kp index which ranges from 0 (no activity) to 9 (extremely high activity).  The greater your latitude, the less geomagnetic activity is required for the aurora to be visible.  The optimal location to view the aurora borealis is within the circumferential band that extends from 60 degrees to 70 degrees magnetic latitude, known as the auroral oval:

When the level of geomagnetic activity increases, the auroral oval starts extending southward, and the northern lights become visible at latitudes below 60 degrees.  There are entire websites dedicated to predicting when auroral activity reaches levels high enough to be seen.   Fairbanks, at the magnetic latitude of 64 degrees, only requires a Kp index of 1 for aurora-watching.  Seattle, at the magnetic latitude of 52.7 degrees, would need a Kp index of 7.  And Mexico City, at the magnetic latitude of 29.1, would need a Kp index of 9+++++++++

Where All the Girls Have PCOS

I haven't been here very long, but I've already seen 9 young women with polycystic ovarian syndrome.  Many have the classic symptoms of irregular menses with anovulatory cycles and hyperandrogenism manifested by acne and male pattern hair distribution on the upper lip/chin & linea alba/periumbilical region; some even have the characteristic ovaries with multiple tiny cysts.  One thing they all have in common is their desire to become pregnant; most of these ladies are between the ages of 19 and 23 and newly married.  Seeing 9 versions of the same problem is like being in some kind of bizarre Medical Twilight Zone.  I found myself prescribing clomiphene for the first time in an attempt to induce ovulation in a 22-year-old with normal FSH (follicle-stimulating hormone) levels and no symptoms of premature ovarian failure; she had been using an ovulation kit every month and was able to document that the last time she ovulated was 12 months ago!

The Irrepressible Urge to Buy Stuff

Something about the cold of winter and the desire to nest fosters an irrepressible urge to buy stuff.  My total time here will be less than 10 weeks, but I somehow ended up with a box of 45 tall kitchen trash bags and 6 rolls of paper towels.  I don't know how to knit, but I seem to have procured an entire set of bamboo size 7 knitting needles, circular needles, double-pointed needles AND a 5.5 mm crochet hook.  Witness my newly-purchased arsenal of thermoses:

Why would you need more than one thermos, one might ask.  One I use for coffee or tea; the other is a food thermos which is spectacular for transporting soup to work.  So far I've made a hearty split pea soup and a surprisingly lovely miso soup with tofu & toasted nori.
The thermoses also come in handy for those special moments when you really need hot water: for instance, when winter elements conspire to encase your car trunk hinges in ice so that your trunk is completely frozen shut.  Because if you're trapped in your frozen-shut trunk without 2 thermoses full of hot water, this trunk release cable will not help you:

Acute Appointments Are Never Quite What They Seem

I've been seeing most of the acute same-day appointments at the clinic, and 95% of them are far more complicated than initially advertised.
Runny nose & sore throat turns into a 32-yr-old G4P3 at 25 +3/7 wks with a history of 3 c-sections, recent gastric bypass surgery resulting in vitamin B12 deficiency, preeclampsia in 2 previous pregnancies...and a positive culture for strep throat!  And did I mention allergic to penicillin?
Urinary frequency becomes a 34-yr-old female with uterine fibroids, polycystic ovarian syndrome with associated insulin resistance, hypothyroidism, and a recent history of endometrial ablation for menorrhagia who stopped taking all of her meds (except xanax!) and has been feeling the urge to urinate Q15 mins for the past 5 months
Abdominal pain is actually a 19-yr-old diagnosed with ulcerative colitis at age 14 who is starting to have frequent stools with blood & mucous after a year of remission without meds...and the nearest gastroenterologist is 360 miles away in Anchorage!
Foot pain is revealed to be a 24-yr-old woman with chronic arthralgia, a recent ANA titer of 1:40 in a speckled pattern and a family history of lupus, awaiting a referral to the nearest rheumatologist 2245 miles away in...Seattle! [maybe she'll let me accompany her to her first rheum appointment and I can check on my apartment and say hello to my peeps at Swedish?]

My Military Cheeseburger

I had my first cheeseburger from the hospital cafeteria today:

Not bad for $1.70...but I've been bringing my own lunch to work almost every day.  Most grocery items are readily available in Fairbanks, only slightly more expensive than Seattle with the exception of certain items like almond butter:

With the lack of sunlight in the winter season,  foods tend to be infused with vitamin D to the maximum extent of the law:

           

My cooking is limited mainly by the sad display of abandoned kitchen implements that came with my furnished apartment: plastic spatula, can opener, miniature cutting board, slotted spoon* (*currently being used to clear snow from the car).

I like to travel with a compact Wusthof knife sharpener if I'm going to be away for more than a month.  It seems less risque than attempting to stash a sharp knife in my luggage and getting tagged as a national security threat.  But alas, the knife in my apartment is cheap, unstable, serrated and very very dull.

I can tolerate a lot of things, but shoddy cutlery is not one of them.  I took a field trip to the cavernous Walmart on the other side of town--purportedly the largest Walmart in the entire country, where people come from all over Alaska to stock up on supplies.

I found a 5" Santoku knife and a 3" paring knife, both significantly more stable than the sad serrated knife in my kitchen.  The new knives sharpened up beautifully after a few rounds with the Wusthof. Now I can slice sweet potatoes without fear of dislocating my wrist.