Bethel, We've Got To Stop Meeting Like This

This is my last foray to rural Alaska before I start my new job in October, and I'm still amazed by the lovely greenness of summer.  All of my familiar icy landmarks have melted away into an unrecognizably verdant landscape of tall grass and bushes.

Some of the hospital patients, however, remain a little too familiar--for instance, the 49-yr-old woman who is frequently admitted for one of two reasons: alcohol intoxication or alcohol withdrawal.  She was just discharged last week, and she bounced back onto my service yesterday.  After multiple doses of ativan and haldol administered at regular intervals, the patient woke up this morning requesting a shower.  She was in that very narrow window between intoxication and withdrawal where she was fairly lucid and cooperative.  Hold her any longer and she goes into a full-blown and very unpleasant withdrawal.  Let her go and she finds enough alcohol to keep herself adequately inebriated to avoid withdrawal.  Since she has never shown any interest in detox or any other treatment, I discharged her and kept my fingers crossed that she would stay out of trouble for at least another week or two.  She beamed at me, looking rather raccoon-ish with her bilateral periorbital contusions, and I couldn't help smiling back at her.