Shishmaref and beyond

I forgot to mention that when in Wales one can see mainland Russia off in the distance. The international date line is also very nearby.

After the long cold walk to the airport. We were soon on our way to the next village - Shishmaref.

This village was larger than Wales and we knew we were in for some busy times.

We flew on the same plane with the same pilot as took us to Wales.

The plane was still cold.

After a short flight we landed in Shishmaref and were soon on a much shorter walk to the clinic.

This time our clinic was located in the health center. It was a largish building with three exam rooms, a pharmacy, a front office and two - for lack of a better descriptor - storage rooms.

The health center is staffed solely by health aides. These are lay people trained to diagnose and treat basic conditions and refer up the chain for extra help. They basically follow algorithms to come up with diagnoses and treatment plans but have physicians, optometrists, pharmacists, dentists, audiologists, etc. available for consultation via fax, telephone, and tele-medicine.

The communities seem to love and trust their health aides.

Upon arrival we grabbed a quick bite to eat and were soon setting up.

The question was where could we set up? We had quite a bit of stuff and the clinic would still be seeing regular patients while we were there.

I asked where we could set up our main exam area and was told to set up in the room "to the left of the kitchen".

Now here is where Swell and I began to get a little angry.

Looking in the room "to the left of the kitchen" I soon realized that there was no way in the world that we could do anything in that room.

To put it bluntly I could barely fit in the room by myself let alone with equipment and a patient. This room was packed to the rafters with a combination of junk, dental equipment and supplies. (Dentists being who they are, are able to leave some of their big equipment in each village rather than lug it around - I'm talking patient chairs, exam chairs, lights, and the like). In addition to all of the stuff there were also file cabinets, a desk and a couple of book shelves.

No way, no how.

We decided forget it we'll set up wherever we like.

We set up in exam room 2, the main hall and a little hall off to the side.

It was not ideal.

Not ideal at all.

The optician set up in a little room to the right of the kitchen - and she wasn't happy about it.

We did the best we could to clear it out but she ended up using our big Tupperware boxes as tables and sitting in an office chair with a drug dispensing table as a desk. Not only was she cramped and uncomfortable she was way in the back of the building with no phone. This meant that patients we unsure of what to do and where to go and she was running back and forth between the office (where she was calling people to set up appointments) and the optical where she would help people with their glasses.

This really didn't work well so the next morning I, without asking, moved her to the front reception area of the building. It worked out much better and we didn't seem to be in the way of the clinic staff.

Swell and I had it tough. I did half of my part of the exam in a little hallway beside her room and the other half in the same room as her. She did her first bit in the main hallway and then the rest of it in the exam room.

It was crowded and unfortunate.

I was finding prescriptions in a way too short hallway with a chart that was a bit out of focus. It was not fun.

When we asked where they usually set up nobody really seemed to know or care. Eventually a patient indicated that they thought in the past that they eye exams occurred completely in the room Swell was in.

I really can't see how that worked but we made do.

And hopefully people's glasses work.

We dealt with a lot of minor disease issues and made a number of referrals both to Anchorage and to ourselves when we come back - we need to so some special testing on some kids and adults that we couldn't do while there.

Here are some pictures of our wonderful examination areas:

The Big E - for the optometrists out there, yes it was only 10 feet away. Yes it was out of focus. Yes I should be killed in my sleep.




New and improved glasses area:


We worked until 9:30 that night. We were happy that they had a TV in the clinic and we watched a little bit while having a midnight snack and unwinding then it was off to the least comfortable sleep ever.

Swell had an air mattress, the optician/assistant had a pull out bed, I had a little mat that they use for medi-vac patients. I was basically sleeping on the floor.

Ouch my back.

The next morning we were up and working by 8:30 and would end a little after 9 pm. It was on this day that we learned that the itineraries we were given were not, shall we say, accurate.

We would not be leaving Friday afternoon, rather we would be working a full day on Friday and leaving "sometime" on Saturday.

Great. Just great.

We were happy that there was a fairly big grocery store in the village although things were extremely expensive. Beyond expensive. We thought Nome was expensive this stuff was nearly twice as much as it is there. I guess thats what happens when you need to fly stuff in.



It was a neat village. Very hilly. Very snowy. Not terribly cold most days.




Beautiful sunrises.


Cute kids wearing wolverine jackets


Dogsleds




Antler Roofs


Rusty Gas Pumps (???)


We worked hard that day and all day Friday - from 8 am until 10 pm on Friday.

We were tired.


I think we did alright work. That will remain to be seen when others look at our charts though. It was hard. It was tiring. My back will never be the same both because of the sleeping arrangements and the awkward position I stood in for a week doing eye exams.

We eventually left not getting back to Nome until Saturday afternoon around 3 pm.

We flew to Nome via three other villages in the wind and ice. It was scary.

Icy Runways




Beautiful views


All in all a good trip.

What's going on?

In the last two days I've examined two patients who were wearing handcuffs and accompanied by an armed guard. I get to see one of them again today.

I just had a little 3 year old girl who I could not examine. Remember I used to teach how to examine kids. I've examined severely retarded individuals, autistic kids, I've been hit and kicked. I've sat on the floor to examine kids. I've sung, jumped up and down, whistled and made silly faces. Never before have I had a problem.

This kid from the moment she walked into the room until the moment I told her Ma that we'd have to reschedule clenched her eyes shut or covered them with her hands. She yelled and screamed. In the fleeting seconds that she wasn't doing this I was able to do about half of the exam. The other half? There was no way.

I hate kids.

Its not a town. Its a village.

Preamble: This is attempt two at this post. This time with functioning pictures?

The week that was, was the week that was.

Difficult.

Professionally.

Personally.

Psychologically.

Physically.

The best way to explain these difficulties is to simply tell you our week. Our week in rural Alaska.

But before we discuss our week in the villages I should go back and post some long promised pictures from our first week in Nome.

This is the entrance we use every morning we are in Nome to get to our offices:


Swell meets a friend named Velvet. (What’s with us seeing animals in the backs of cars?)


One of our views. (Ignore the shadow on the right corner. Somehow I jacked my camera up. I’ll need to get that fixed when we’re in Washington).


Our gourmet kitchen.



Eskimo Dancing



Sunset over the Bering Sea





The most beautiful girl in the world




Late last week we received our travel itinerary for village week. We were to leave via Bering Air on Monday around 10 in the morning and return on Friday February 29 in the late afternoon. Being the ignorant Southern 48ers we are we packed according to this itinerary.

When we flew up here from Atlanta we packed in two large suitcases and a duffel bag. I didn’t think that the large suitcases would make for appropriate village travel luggage so we squeezed our weeks worth of clothes into the duffel bag and Swell’s small backpack. My backpack is suitable only for my camera and a computer so all of our belongings were relegated to the aforementioned duffel and backpack. We were also required to bring our sleeping bags and most importantly food and water for a week.

We were graciously lent the clinic’s cooler for our food.

In case you didn’t realize – it was extremely difficult to accomplish this packing feat.

We were able to shove and squeeze everything into our allotted luggage but were forced to cut some clothes and shove some food into the duffel.

We were set.

But not prepared.

In the midst of our packing we were asked to go to one of the hospital’s big-wigs home for pizza.

A nice late welcome?

Nah, we were going to the “lets-convince-a-yet-to-be-graduated-OD-to-move-to-Nome” meet the staff dinner.

Funny enough only one of three staff members made it to the dinner but both Swell and I made it.

We actually left Nome and headed to the bustling Nome suburb of Icy View.

While I was packing a thought popped into my head, I thought; “Self the name of this optometrist they’re trying to convince to come here seems so familiar. Where do I know that name from?”

And then it dawned on me.

A number of years ago I wrote this person an unsolicited email.

Why would I do that?

Because I’m an ass.

This person wrote a plea on the internet for connections to plan a trip to Belize for an optometric mission. I had just done a case study on eye care in Belize in Public Health school so I wrote this person what I thought about eye care missions and that they should contact one of two groups – the Ministry of Health or a non-governmental organization working on eye care in Belize – if they decided to go forward with an inappropriate mission. (My email was worded nicely and there is good reason to discourage foreign eye care in Belize – the good reason is that optometry is developing along a very public health path in Belize and should be aided before foreigners run in and throw glasses at the people).

Surprisingly I never heard back from this person but learned later via other sources that they did contact and work with the NGO I suggested.

The pizza party was good. We visited with the potential OD and encouraged them to seriously consider coming up here all the while wondering why we were never given the sales pitch they were giving this person.

I suppose we weren’t given the sales pitch because we never expressed any interest in staying here more full time. On Monday and Tuesday while we were slaving away in the villages the potential employee was being interviewed, given tours, and told about the potential for loan forgiveness through Indian Health Services.

I could sure use some loan forgiveness.

Monday morning eventually rolled around and we were soon ready to head to the airport.

In order to save space in our luggage we both got dressed with long underwear, jeans, ski pants, boots, undershirts, thermal shirts, jackets, toques, gloves and anything else we could think of.

I called for a cab thinking that it would give us another 15 minutes or so to finish getting dressed. Upon calling the cab company I was told “We’re on the way.”

No lie 1 minute later the cab pulled up to our door.

We threw our boots on ran out and were soon on our way to the Nome “airport”.

“Airport” because it’s actually one runway and every airline has its own little terminal building.

The cab drivers act as their own dispatchers. We heard a funny exchange between the cabbie and a potential passenger.

Cabbie Checker Cab
Woman’s voice Can you come and get me at X hotel?
Cabbie Where to?
Woman’s voice The hospital
Cabbie Ok. I’ll be there soon.

Two minutes later
Cabbie Checker Cab
Woman’s voice Are you coming to get me from X hotel?
Cabbie I’m on my way. (by this time we were fully loaded with passengers – the cab is a van and it picks up multiple fares and makes up the most efficient route to pick up/drop off fares – and on our way to the airport which is a little way out of town).
Woman’s voice I’m having some chest pains and I need to get to the hospital
Cabbie I’m on my way to the airport so you should call the hospital and ask them to send the ambulance
Man’s voice – apparently another cabbie listening in Call 911
Woman’s voice I’ll be waiting outside
Cabbie – shaking head Ok. We’re on the way.

We arrived a little early and had to sit and wait to check-in. I suppose we didn’t have to wait but Swell wanted to wait until our optician/assistant arrived at the “airport” and all check in together.

We waited. And waited. And waited.

Eventually the front desk people told us we needed to check-in. As our concern grew that we were being stood up and wouldn’t be able to function on our own the optician/assistant arrived.
As part of the check in process you are required to give your weight and weigh every item that will be carried onto the plane.

That should tell you something about the size of the plane we flew on.




Soon some kid who looked about 12 years old with some five o’clock shadow walked into the waiting area and said “Brevig/Wales”. We followed him out the door onto the tarmac and onto the plane.



We were flying in a plane called a caravan. It seems to be a true bush plane. Being able to be transformed to carry people or goods or some combination of both.

Once on the plane both Swell and I were very grateful that our small luggage forced us to dress in all of our warm clothes. Soon after putting on my seatbelt I realized that not only was it chilly on the plane but I could see my breath.

I was slightly shocked when the 12 year old guy who walked us out to the plane got in the pilot’s seat and strapped in.

It was going to be a long plane ride.

We flew to Wales via another small village where we dropped some people and goods off. Soon we were approaching “windy Wales”.

Upon arrival we hopped off the plane and started the long walk to the village school where we would spend the next two days and nights. I carried my backpack, a sleeping bag, and Swell’s pillow while she carried her backpack and a sleeping bag.

It was cold and I’ve been cold before. I mean cold, cold not just regular cold. We walked, and walked, and walked. At one point the “snow machine” (aka snowmobile) that was our luggage cart came by with the second half of our luggage and picked up the optician. Swell and I continued to walk and walk. Eventually the snow machine picked us up. Swell sat behind the driver and I sat on the sled behind it hanging on for dear life with my backpack weighing me down and the sleeping bag slipping from my grasp.

Fun?

Ummmm…no.

We got to the school and immediately started to unpack and set up. The optician/assistant also began to man the phones phoning those who had signed up for an exam to set up an appointment for them.
We were a little shocked by the room we were given to work in. It was basically a large storage room. We did our best to set up in a way that would be at least somewhat functional while being clinically appropriate.

Our exam room




View through phoropter (prescription checker)


We began seeing patients at around 11:30 and finished for the night around 8pm.

We saw a lot of kids but also many adults. Everyone was very grateful that we were there and were very friendly. It had been a couple of years since a Norton Sound Health Corporation eye team had been to Wales but there are a couple of private outfits that fly to villages to do eye exam and sell glasses. The bad thing is that they don’t do follow up care or report to Norton sound. While it’s not necessary to share findings Norton sound provides the rest of these patient’s healthcare so it would be nice to have complete charts.

Just another little problem in the provision of care to those in rural areas.

Toward the end of the day I was met with the best of all news.

Every evening the school gym was open for people to play basketball.

For much of the evening a little store was also open that sold soda and candy.

Much to my excitement not only did they sell Dr. Pepper it was actually quite cheap – only 75 cents per can.

I was ecstatic.

The work was difficult. We were busy. Our equipment left much to be desired. Many of the folks had difficult problems that we were unable to completely deal with. We were not sure how to refer, where to refer, or when to refer.

Again, a manual – policies and procedures – would have come in handy.

The big excitement in town was that there was a Polar Bear spotted in town recently. We were told not to venture outside – not that we had time to – and the children were told to walk on the town side of the school rather than the water side.

Wales is a very small village with less than 200 inhabitants. The post office was closed while we were there as the post master was at a conference.

The school has five or six classes which are not grades per se; rather the children are grouped according to “level”. If you reach one level you’re geared for general life. If you want to go to college or trade school you have to reach the final level.

From the papers posted on various bulletin boards it seems that the kids are quite bright and well taught.

We met one teacher who is originally from Oklahoma and has been teaching in this little village for 10 years now. She mentioned that most of the staff had been at the school for years now.

Very impressive if you ask me. Important for the kids’ education as well. Continuity is important.

We met one girl who wants to go to optometry school – or not. It said in her chart under occupation “future optometrist” so we talked to her about it. Like most people she didn’t realize that it was a post-grad degree so we’re not sure if she’s in it for the long haul. We gave her Swell’s email address and have already communicated via email about optometry school.

As we prepared for bed we realized two things:
1) We would be sleeping in a classroom – the younger kindergarten age kids’ room and
2) There were others sleeping in other classrooms.

We’re not entirely sure how many people were spending the night in the school but I think there were three groups in total – us, some folks working on the schools plumbing issues (?? – An interesting plumbing side note in both villages we stayed in they had indoor washrooms for us but both contained signs bearing the clever albeit off colour saying If its yellow let it mellow. If its brown flush it down. In Wales the bathrooms also bore signs indicating that they were only to be used during school hours due to “freezing pipes”. That made for some long nights. Nah, we ignored that sign and some ignored the latter part of the first…if you get my drift.) The third group was a couple of young guys – Glaciologists – from the University of Alaska doing some research on the sea ice. I’m sure their conclusions will not bode well for humankind. They were nice although a little disappointed by our presence. Apparently the storage room/eye exam room is also the Glaciologist’s equipment cleaning room and we were in their space all day.

Our beds were grand.



But our sleep was not sound.

The next day started with a wonderful breakfast of water and a granola bar. We were both tired and my back was sore (and still is). Despite that we worked.

From 8:30 am until 9:00 pm.

Four patients an hour (with two ~45 minute breaks for lunch and dinner).

We each shared the patients and a routine that would carry through the week was developed. Swell would start the patients and I would finish with them. I think Swell had it harder, she thinks I had it harder. I guess that means we found a good balance.

Looking out the unfortunately placed (for an eye exam lane) window one could see why the village is called “Windy Wales”. It looked absolutely miserable out.


We were glad to be indoors in the too light exam room during the day and too dark exam room during the early morning and night. Swell was struck with the realization (and I’ll avoid using this opportunity to say I told you so) that she in fact did not need the heavy sweaters and pants that she packed as – surprise, surprise – they actually had good heat in the school. She was sweating like a pig. Ha!

The day was uneventful, although our last patient before dinner spent quite a bit of time talking to us about the changes he has seen in Wales. Mentioning that usually by this time of the year they have seen 8 or 9 Polar Bears but this year just one. He mentioned that the weather has changed drastically in the past number of years. He didn’t say why he thought these things have happened. Perhaps global warming we pondered, perhaps just a regular weather cycle. He didn’t know. We couldn’t offer an explanation but it was an interesting ten minutes learning about life in Wales.

Yet another life experience I couldn’t ever have imagined having: standing in a school hallway talking to an Eskimo about life in a tiny village in rural Alaska.

We went to bed that night knowing that this was our last night in Wales. We would wake up the next morning and work for a few hours and then pack up and fly out to Shishmaref.

That night Swell was shown the shower.

There was a shower (limited to a total of 2 minutes).

She states that it was so powerful that one couldn’t stay more than two minutes even if one wanted to.

I turned down the shower.

I’m a man’s man.

Stinky.

The next morning we woke up and started working again.

We worked.

We ate our PB and J for lunch.

I packed up the equipment while Swell walked to the only open store. It turned out to only be a grocery store. She was hoping for a hand made goods store.

We had opportunity to buy things made locally.

The first things one of the patients brought was beautiful. It was an Ivory carving of little Eskimo guys dancing.

It was $750.

We said no.

We also said no to the $150 crafts and the $85 ones. Well, we said no to everything.

Far too rich for our blood.

We decided that it would be fun to walk to the "airport" to take some pictures.

It was sooooo cold. Colder than the first day. The coldest I've ever been.

Some pictures of our walk to the airport as taken by two frozen cameras.









Yes I'm stupid. Yes its on upside down. My excuse - I didn't put it on until outside and my fingers were freezing.



Next installment

Home

We're home in Nome. A day later than expected. Will post more (a lot?) later.

Miss us?

We're in Wales.

Look it up on a map.

We're exhausted but have much more to do today.

Have sporadic contact with my three loves:

Swell
Dr. Pepper
Internet

Leave tomorrow.

Will probably lose contact with two of my three loves.

We'll see.

Back in Nome on Saturday (Friday night actually).

Will write more then.

Haven't missed us I see.

The Bread is Fresh...

So we're at the endish of our first week. It has been extremely challenging on many fronts.

First the good:
It has been awesome to be here with Swell. We don't see a tonne of each other during work but its nice to get home at a decent time 5:30-6:00 and sit and watch TV or DVDs together.

On Wednesday we were invited to go to the local Catholic Church where some Eskimo folks were "practicing their dancing". We weren't entirely sure what that meant but after arrving realized that we were experiencing one of the coolest things I've experienced in my life. It ranks up their with sitting on a roof top in Palestine listening to some locals play music (in '99). It also ranks with when I was sitting in the back of a truck in rural Honduras zipping along listening to the frogs croaking. On Wednesday we sat in this Catholic church and listened to three men play traditonal drums and sing. Whenever anyone felt like it they would jump up and do a dance associated with the song being played. What I found most interesting is that there were many young people there (12-14 years old) and would at times be the only person dancing. It was actually (for this bleeding heart) a very moving experience and one that I won't soon forget. I'll try to put some pictures up but that will require going to the pizza place and spending a bunch of money on lunch or dinner (this Sunday or tomorrow for dinner).

The patients here are very challenging. They people are beyond nice but they are a sick/old population (the ones we're seeing this week any way - remember that they are all diabetics this week). The previous optometrist was meticulous in her note taking and I would argue extremely conservative in her treatment plans. Swell and I, having worked in the worst of all situations, are far less likely to call something a problem. It makes it difficult to reconcile our findings with the previous optometrists. We were astounded by how much the previous optometrist did but have come to find out she was really only doing one exam an hour. We will be doing at least 2 an hour each.

The negatives are just things we have to learn to live with.

A lack of communication is a big one. There is no one "in charge" of optometry here. No one really seems to know how things work. There is no policy and procedures manual. We are going out to villages all next week and were told to make sure we had all the necessary equipment ready. Most of it was already packed away but we really don't know what we need as we've never done this before. If I were ruler of the world I would make a manual that states bring this and that for every village trip. No such manual exists. This wouldn't normally be a problem because there were two optometrists here but because both quit there is no senior OD here to guide the Jr. ODs (us).

In the villages we really only have enough equipment to be doing one exam at a time. We'll have to figure out a way around this.

We have to bring our own food and water to the villages. We only have one duffel bag and then a tourist style suitcase. We can bring as much luggage as we want but I don't think a four wheeled suitcase is going to work well in a small rural village.

Because they are without an optometrist we are pushing a lot of "special testing" off. Many of the charts have the notation to do a visual fields in a year, or photos, or someother non-regular testing. Well, a year is up but we can't really do this extra testing as we don't have the time. We tell them to come back in a couple of months and hopefully we will be here and able to do it or they will have hired someone.

A yet to graduate optometrist is coming by sometime this week or next to tour the facilities. They hope to hire this new grad. I couldn't have done this work right out of school but I hope that this new grad is willing because they really need someone.

Well thats that. We haven't been overwhelmingly busy because a couple of villages were snowed in and the folks couldn't make it into Nome.

I should explain that there are medics in many of the villages (these are well trained lay people who are able to prescribe some medications and take care of minor issues). They can also communicate with providers in the hospital and send pictures and questions for guidance. (Telemedicine at its finest).

Once in a while a specialist comes to Nome and all those requiring help from said specialist come into town to be seen. Physicians also travel to the villages on some set schedule.

It is a very public healthy set up and seems - albeit from the outside looking in - to be an efficient method of providing care to the local people.

We were in Safeway yesterday as a man took bread of the shelf he exclaimed: "The bread is fresh today!" He proceeded to thump it and explain how he knew it was fresh "Its still frozen!"

Thats Nome in a nutshell. Fresh bread is still frozen bread put out on the shelves.

Its been fun.

Day 1

I'm sitting in the smaller of our two offices here at the hospital. It is quickly approaching quitin' time.

The end of a hard day approaches.

Not hard because we were so busy. Not hard because the patients were so complicated.

Just hard because its always hard to start a new job.

Not knowing where things are. Not being familiar with policies and processes are always difficult.

They were especially difficult today simply because we are working in a hospital.

Mounds of paperwork.

No simple drawer full of new supplies, rather one must go to the pharmacy or supply room to obtain replacement drops or things.

New equipment is always a little difficult in the beginning. While it is true that everything works the same it just takes a little while to get used to where this knob is, and that button is.

My exam lane is the smaller of the two. Smaller simply because it is filled to the brim with extra equipment that isn't used regularly. I've really been struggling more than Swell I think.

I was getting more and more frustrated as I tried to figure out why it felt like I was moving in slow motion and everything just seemed really difficult.

It finally dawned on me.

I'm working in a left hand room.

Everything I'm using is on the opposite side of the room that I'm used to.

Not a big deal but its throwing me off. Physically and mentally. Just being in a weird room is causing everything to be just that much more difficult.

I'll get used to it but its going to take some time.

Nice weather today. Very warm, although we won't really experience it as we're here all day and then have a short walk home tonight.

There is no place like Nome

So we are sitting here in Airport Pizza just waiting for the waitress to bring Swell's Latte.

Needless to say Swell is ecstatic that she has the availability of Lattes, Cappuccinos, and Espressos.

Airport Pizza is one of many restaurants in Nome. It is, however, the only one we've tried thus far. We've now eaten here twice.

Our first meal here was a lunch where we got a very expensive, yet yummy, pizza. Believe it or not we had Reindeer sausage pizza.

It was quite good. We felt like doofus tourists ordering it but I've come to find out that it is actually quite popular.

Today we each had a burger. I had a true beef burger whereas Swell had a Garden burger. Both were quite good but, again, expensive.

Everything is extremely expensive here. We were expecting expensive but were still a little shocked. Swell is going to write down the prices of some of the things at the grocery store to share our shock. To give you some idea I'm looking out the restaurant window at the nearby gas station - $4.29/gallon. And we're told that's very cheap for Alaska standards.

Our little apartment is warm. That's really all it is but we're not complaining. We are warmer indoors than we were this time last year.

Much, much warmer.

Outdoors is another story, though.

Anyway our apartment is a two bedroom one bath complete with washer and dryer - yippee - but is filthy.

Disgusting filthy but not the kind of filth that can be cleaned. Its just the type of place that has seen many different tenants - I believe its owned or rented solely for the use of the hospital. Stains of unknown origin on the carpets and walls.

Rickety furniture.

But its fine. We're treating it like a camping trip.

Scrounging for food.

Sleeping in sleeping bags.

We haven't done much the last few days. We're just trying to acclimatize and get used to the time change.

We've been watching TV (they have provided us with cable) and DVD's (on my computer). We did venture out a little bit each day.

It is a very small town. Population ~3500. Everything worth going to is in a short distance from our apartment. Front Street is the main drag - complete with bar after tavern after watering hole - and is right on the Bering Sea - which is, of course, completely frozen.

The temperature has been very bearable. We think it was actually much colder in Edmonton over Christmas. We, of course, also have much better/warmer clothing here.

We start work on Tuesday. This week, as we've already mentioned, is simply diabetic eye exams. No set schedule. Folks from around the Norton sound area will be coming in for their annual diabetic meetings with the nurse, physician, and dietitian. At some point they will drop by the eye clinic where we will check their eyes for any diabetic complications. So we'll be busy in spurts. No big deal. It should be fun.

We have internet at work and then here at the restaurant so we'll be in touch this week but out of touch next week.

Sorry for the rambling but it is difficult for me to write fast and entertainingly at the same time.

Some pictures to end the post.

Nome began due to Gold Rush



Front Street


Tourist Center


Iditarod finish line - They pull it out at the end of the race but it sits outside all year long


We could walk to Siberia - we could if we were crazy.

Nome Sweet Nome

Here.

Not that cold.

Apartment is...interesting.

Orientation half day tomorrow.

Long weekend due to Presidents Day on Monday. Start working on Tuesday.

Later.

Cold?

We are sitting in the Anchorage airport waiting to board our last flight of the day. We will fly to Nome via another town so we have two more takeoffs and two more landings to go, although it is only one flight.

Lots of snow outside. Doesn't look too cold here but we have a long journey North yet.

Uneventful day thus far if you discount the ticket lady in ATL, the big guy squishing me on the second flight and the SCREAMING kid sitting right behind me.

All those who read this and are sick you better get better immediatley. All those who read this and are being silly with your lives better cut it out immediatley.

Ok that's it. My thumbs hurt and I don't like not having a spell checker.

We're on our way

So we will be leaving our house via cab (or more accurately "luxury sedan" - same price as a cab and way more cooler) tomorrow morning at 6. Our flight is at 8:30 am and we arrive in Nome, via Seattle, via Anchorage at 8:30 pm. 16 hours of travel time (remember the time change people) and we'll be in Nome.

Here's hoping our flights are on time and without incident.

Swell is excited by the fact that there is a 100 degree Fahrenheit difference between Nome and our holiday location of Maui. That will be a shock to the system.

We've already been asked to make this a year long deal.

We'll see.

I don't know how much access we'll have to internet but I get all my emails pushed to my phone immediately so you can stay in touch that way.

I'll also try to update here via phone if the internet is not working.

Later Gators.

Put it out of its misery

Before I start this post I want to explicitly state that we love our car and are very grateful for it. It was a gift Swell's parents gave her for Optometry school graduation a number of years ago. Since then I have purchased it from her. (Click here for a reminder as to how this car became my property)

That said this car has become more trouble than its worth over the last few weeks.

As the car approached 115000 miles we figured it was oil change/tune up time. No problem. I could take it in on a Monday or Thursday. Mondays both Swell and I had off but we're often out and about doing errands, shopping,etc. Thursdays Swell worked but I had the day off and could drive her and then head back to the car place and they would drive me the mile or so back to our place where I could do my weekly cleaning. (Of the house, not of me. I clean myself monthly whether I need it or not.)

Hating talking on the phone I had Swell phone to make the appointment. She tried a couple of times but their phone just kept on ringing. After learning of this non-answered phone business I did what any sane individual would do.

Find a new garage?

No. Book an appointment on line.

The next Thursday.

Me: Bye Swell. Have a nice day. I'll see you later.
Swell: Let me know if they find anything wrong with the car.

Twenty minutes later.
Me - on phone: Ummmm...Swell... I don't think they're open anymore.
Swell: What! They're not open?
Me: Correct. They are not open anymore.
Swell: That's strange. I guess we'll have to do it another time.

Three days later
Swell: When are you going to take the car in?
Me: I don't know where to take it... I'll have to search on the internet for another Ford dealer.
Swell: Why don't you just take it into the dealer we always take it.
Me: FOR THE LOVE OF ALL THINGS HOLY, DO YOU NEVER LISTEN TO ME!
Swell: What?
Me: Remember? I was taking the car in last Thursday and I phoned you and said they weren't open?
Swell: Well, of course I remember that. What does that have to do with taking the car in this week?
Me: I DON'T KNOW WHERE TO TAKE IT! I'll have to look for a new dealer online or something.
Swell: I DON'T UNDERSTAND WHY YOU CAN'T JUST MAKE A NEW APPOINTMENT AND TAKE IT WHERE WE USUALLY TAKE IT.
Me: Oh my goodness! You really don't listen. I just told you that they were closed.
Swell: Its not like they're closed forever, stupid.
Me: It's exactly like they're closed forever. All the cars that were for sale are gone. Its just a big empty lot now.
Swell: Oh. I thought you meant they were just closed last Thursday.
Me: That doesn't really make sense does it?
Swell: I didn't think it made sense but you said it and most of what you say doesn't make sense.
Me: That's true.

So after that fateful misunderstanding I said something to someone once about not posting personal stuff (like fights) in a blog so I just want to reiterate that I exaggerate our disagreements although the underlying story is true. It is very true that we had a complete misunderstanding of what "They are closed" meant. It was quite funny. I searched and searched for another Ford dealer.

The nearest one wasn't really all that near. About 7 miles from our place, which is a long way in Atlanta.

So one fateful Thursday I dropped Swell off at work and made my way to the new Ford place.

Upon arriving I was impressed with the customer lounge, not so much with the neighbourhood.

After telling the garage dude that we needed i) an oil change ii) an inspection to look for any problems and iii) an explanation as to why the car was idling poorly at stop lights I went looking for a place to hang out.

Me - on phone: Swell, I'm a little bit a feared. This place is in the ghetto, and not the ironic cool ghetto I mean the actual ghetto and its freaking cold out today.
Swell: Don't care.
Me: Well ok then. I'll call you when the car is done.

I eventually found a place to eat. Who would have expected to find a Chik-Fil-A in the ghetto? (Ok that was crossing the line I know. It wasn't really a ghetto. It was just a rundown part of the city with a lot of shady people hanging around. And truth be told where isn't there a Chik-Fil-A in Atlanta?)

After my nutritious lunch I walked back to the garage and sat for five hours watching Scrubs on my computer.

Oil Change? Check!
Explanation for poor idling? Check!
Fix idling problem? Check?
Cheque? $600
Check the brakes? No. Although they were supposed to. Its on the sheet. The just marked. Didn't do.

Why would the brakes be important?

A few days later.
Swell on the phone: Ummmm, dear husband of mine. Remember when you took the car in. I told you to make sure they checked the brakes right?
Me: I know. They were supposed to. How am I to know that this new garage just ignores that part of the multi-point inspection?
Swell: BY TELLING THEM TO CHECK THE BRAKES!
Me: Sorry. Are they worse?
Swell: If you consider a combination of an ear splitting screeching and a headache inducing grinding worse, than yes they are worse.

The next Thursday I was on my way to yet another Ford Dealer.

My long walk this time led me to a Wendy's followed by 4 or 5 hours of The Office on my computer while waiting in the not as nice customer lounge.

Brakes fixed? Check!
Cheque? Another $600

One day later toward the end of a very long Friday.
Swell - on phone: I'm on 400 and the car doesn't sound right.
Me: What's wrong?
Swell: I don't know. It just doesn't sound right.
Me: I'm sorry. Drive slowly and try to get here. I can't really do anything else from here.
Swell: Ok.

Ten minutes later
Swell: It sounds even worse now and its not going very fast.
Me: Maybe you should pull over.
Swell: I'm on 400
Me: DON'T PULL OVER!!!!

Ten minutes later
Swell: I made it. I'm in the parking lot where should I go?
Me: Just find the nearest parking spot.
Swell: I think maybe the tire is flat.
Me: Just find the nearest parking spot.

Ten minutes later.
Me while looking at the huge piece of metal in the tire and the blown sidewall: Well, you're lucky you're not dead.
Swell: You're not supposed to drive on a flat tire?
Me: No dear.

20 minutes later.
Swell You'll stay open for us? We're almost there. We're just driving on a doughnut now and we work tomorrow so it would be great if we could get it fixed tonight.

2 hours later.

Tire fixed? Check!
All other tires ok? Check!
Cheque? $250.

Since then? So far so good.

Don't Phone Us

Well we got rid of Sprint. They hosed us a little and we weren't able to port our numbers. So don't call us. After living in Atlanta for over 3 years we finally have local numbers... just in time to move away.

If you don't hear from us in the next couple of days via email or phone and you want our new numbers drop us a line. For the next day or two we'll be going through our contacts and trying to figure out who needs our numbers.

I love Atlantans

Swell had the brilliant idea to weasel out of our cell phone contract by indicating that we were moving to a place that had no cell phone coverage.

We're not entirely unhappy with Sprint but would love to get out so that we could really weigh our options (particularly with phone availability - Sprint has the worst selection of phones in the world). We refuse to pay the cancellation fee so I thought I'd head over to a Sprint store during my overly slow work day, and ask if we could, in fact, get out of our contract without the exorbitant cancellation fee. I'd read that they are willing to forgive the fees if you can prove you are moving to a location without coverage.

Worker Welcome to Sprint. How can I help you?
Me Well, believe it or not my wife and I are moving to Nome, Alaska.
Worker Where's that?

Ok. Now I'm not the smartest person in the world. My intellect, unlike my stunning good looks, would probably fall smack dab in the middle of the intellect bell curve. Average at best.

That said, I know where Alaska is. I might not have been able to point to Nome on a map without a hint or two but if someone said I'm moving to Nome, Alaska I wouldn't say "where's that?". I had hoped that anyone in this country would have a vague idea where Nome, Alaska was.

The worker's response begged the question, did they not know where Alaska was? Did they know that Alaska was, in fact, part of the US?

Me - dazed and confused Ummmm... well... it's about as far north as you can get in the United States.
Worker - doubtful as to the veracity of my geographical knowledge and future habitat Yeah, let me check on that.

I tell 'ya the education system needs a good overhaul down here.

Any Americans who care to chime in. What cell service do you use and is it worth getting?

Cheers!

I'm gonna try out saying Cheers now. I don't know why. I just feel like doing it. By the way we applied for positions starting January '08... in New Zealand. They may or may not have openings at that time but have asked for two referees from us. Where can I find a referee? Do I just approach them after a hockey game or what?

Silly Girl Getting Ready

Silly Girls Wii-ing. (Long exposure with attempt to show movement. Kinda worked)

Now that's what I'm talking about

Hi Headhunter woman,

During SwellandSheepie's 3 week visit, we have schedule a village trip 2/25-2/29. They will travel together on one of our smaller airlines to two remote eskimo villages. 1 village is Wales, AK and one village is Shishmaref, AK. They will travel with the optician here and she will orientate them to the clinic and be there the entire time with them.

They will all stay in the village clinic overnight. It is safe there and there will be separate sleeping areas for Pearce's and the optician. However, if they have sleeping bags, they may want to bring them. Most clinics are equipped with cots.

I am writing to make sure they are up for the trip. We will pay for the airfare, etc. The lodging is taken care of and they can enjoy the experience.

Please let me know if there are any problems with this. Wales does not have "running" water. There is water and there is a local store, but no actual running water. There are showers available.

I think they will love it. The other two weeks will be spent in Nome. We have an annual diabetes clinic 2/19-2/22. The entire week will be used to see our diabetic patients. We usually have about 70 patients come to town for this clinic, so that week may be busy.

(emphasis mine)

Bad Days

I've had some bad days as an optometrist. Some really bad days.

Patients yelling.

Staff glaring.

Patients glaring.

Staff yelling.

Busy.

Slow.

Confused.

Saturday was one of those days. But I don't know why. It wasn't particularly busy (20 patients for full exams, five or so for miscellaneous junk). I didn't get yelled at or about. I received very few glares. It was just a difficult day made worse by a complete lack of desire to be here.

We don't like it here Sam I am.

Not a bit.

Not a little.

Not a lot.

Not at all.

It is time to move on. From Saturday at 7pm to Monday at 5 pm we are relatively happy people but as the fact that we have to return to work on Tuesday begins to sink in early Monday evenings the dread starts.

From Swell's long drive and staff that hate her to my just hating working at a mall and seeing walk-in after walk-in our work weeks are killing us.

Why can't work be fun? We went to school for a long time. We demand fun.

Instead we get no fun.

We hope that Nome is fun.

They were supposed to have purchased our tickets at the end of last week. We approved the flights and they were supposed to buy them.

I hope they did.

If they didn't...

We've given our notice here and are ready to go.

We hope to be challenged professionally.

We hope to learn optometry.

We hope to learn about others.

We hope to experience Alaska.

We hope our plane doesn't crash.

Swell's Ma is coming to visit this weekend. Every couple of weeks her schedule works out in such a way that she has four or five days off in a row. She can fly cheap so she is coming to see us. While cleaning for her arrival I came to the conclusion that somehow we have too much stuff. We have so much stuff we don't have enough room for it.

Now remember that a lot of it isn't our stuff. It is stuff for Romania. Swell has a dream. Her dream is to fill four suitcases of stuff for others and take our clothes and the like as carry ons. In the meantime the stuff multiplies, much like the stereotypical rabbit, and accumulates in our rather small condo.

We trip over stuff.

We sit on stuff.

We push stuff aside to clear but a little room to walk.

I exaggerate of course, but suffice it to say there is Romania stuff on top of stuff we need to part with.

Thats one good part of moving.

Purging.

I'm semi-proud of us for purging much of our optometry school notes. They are now in a landfill somewhere near Nablus.

I'm semi-proud that we purged clothing upon our return 6 months ago. They are now in a Goodwill somewhere (or in someone else's closet).

We now need to do some more purging. If we're going to sell our place it can't look like its bursting at the seams. We have too many sheets and blankets.

We have too much Christmas stuff.

I have too many books and CDs.

The time to start purging nears.

And then packing to move...

I hate packing.

I'd rather work here than pack.

Interesting observation

When it is 9 am in Atlanta it is 5 am in Nome.

This morning at 9 am Atlanta time the temperature in Atlanta was 21F/-6C (with wind chill 7F/-14C).

In Nome at 5 am this morning the temperature was 31F/-1C (With wind chill 19F/-7C).

Strange, no?

Pictures from our second winter storm this week!

As I sit here waiting for Swell to pick me up after another hard day's work the metro-Atlanta region holds it's collective breath.

Children are on the verge of tears.

Women are shivering.

Men are prepping.

The mayor is on alert.

Principals are manning the phones.

TV stations are preparing for round the clock coverage.

It is snowing.

A lot.

A veritable blizzard.

A southern blizzard but a blizzard none-the-less. White flaky moisture is falling from the sky. A snow day is in the making. Shovels need to be sharpened. Scarves need to be tied. Snow needs to start sticking 'cause nobody wants to work tomorrow. If there is a dusting of snow in the morning work, school, and life will be temporarily halted.

It just might happen.

Snow days are still an enigma to me. Why should a little snow stand in the way of living life? You can walk in snow. You can drive in snow. You can work in snow.

I guess I should say I can walk, drive and work in snow. The rest of the city? Apparently not.

Swell has a long drive ahead of her and if people drive in the snow like they do in the rain here I won't see her until tomorrow. Although I can't see her I am sure she's blue.

Not from the cold but from holding her breath. She would be over the moon ecstatic to not work tomorrow. Thursdays are her most dreaded days. She really struggles at the location she works at tomorrow. Suffice it to say that her Thursday location is not a fun work environment.

Her Tuesday, Wednesday, Friday, Saturday work place is a soap opera. Her ADD/Tourette's/OCD/Druggie co-worker has at long last been fired. His replacement. A know-nothing know-it-all who thinks she actually has a say in how the store runs. A manager who has nobody to manage. A new comer to the wonderful world that is optics but has been left to run an optical store. I'm sure if Swell ever becomes un-lazy she can tell you stories.

We've been busy the last week or so buying stuff for Alaska... but we're not entirely sure if Alaska is happening. We're sure. The company that was hired to find us is sure. The hospital where we'll be working? We have yet to receive word that our tickets were purchased although Swell found some tickets for a song a week ago.

We've each purchased boots. We each got a few more sweaters. Swell got socks, 4 coats, mittens among other things.

We're looking forward to going...

...if we get to go.


As an aside. I was sitting next to a real catch the other day before work. Any of you single ladies out there might want to give me permission to pass on your info to him. I'll probably see him tomorrow!

This guy was talking on the phone to a woman he obviously has not met and is speaking to for the first time. I think that he got her contact info from some type of online dating site.

He says, and I quote: "I have booty calls on speed dial so thats not why I'm talking to you."

Surprisingly he is not hung up on. The conversation continues with him asking "Where are you from?"

Following her response I hear the following:

"New Orleans! I'm in New Orleans right now!"

We were of course in downtown Atlanta.

Winner!!!

An Update is in Order

Well I guess it's been long enough without a real update. Might as well say whats going on in our lives.

We left to go to Alberta for Christmas early on December 23. Upon arriving at the airport we were curtly told that we were being taken off of the Chicago leg of our flight and put on a flight through Denver. This was to delay our arrival in Edmonton by 2 hours.

Upon arriving in Denver we were told that our airplane had not yet arrived and our flight would be delayed until they were good and ready to send us to Edmonton. Surprisingly this was only an hour delay. We arrived in Edmonton 3 hours late upset that we purposefully spent more money on our flights to avoid getting into town in the later afternoon.

Oh well. We were there and it was Christmas.

We stopped to finish up some shopping on our way to my parent's house. (We didn't really do much in terms of gifts this year. We really just got people a few trinkets from our travels and then framed some photos we've taken over the last year. Inexpensive and homemadeish gifts.)

We spent the next few days doing Christmas the way only my family can.

Loud.

Overdone.

Messy.

Gouty.

But so much fun.

It was great to be with my family again. We've been lucky this year having seen quite a bit of both sides of our family.

After Christmas it was time to head back home to Atlanta. We took a red eye arriving in Atlanta around 11 am. I was 45 minutes late for work (supposed to be there at noon but our flight was delayed out of Chicago so I didn't get there until 12:45. Oh well.)

Swell and I both worked the day we returned. We were exhausted for the next few days and have just found the time and energy to unpack and clean our house. We received lots of neat things from family from books and clothes, to Wii's and DVDs to money and souvenirs. It was a great week at home.

Since returning to Atlanta we've been working and growing to despise it here even more. Swell has gone off the deep end at work. Everyday I am required to hear story after story of what a terrible place it is.

I've had enough.

I told her that no matter what she wasn't allowed to work there past mid-February.

Luckily we officially have other work beginning mid-February. On Feb. 13th or 14th we'll be flying out of ATL to head to Nome, Alaska. We will work for three weeks and then fly to Portland, OR to visit Swell's Parents. After the amazing time we will have there we will fly out of Portland to visit Gilda in Maui.

Its a sacrifice for us but its our turn to visit. It will be tough to spend 11 days in Maui but its what we do for friends.

We're good people.

The best people.

But now I have to get into swimsuit shape. Haven't had a Dr. Pepper all year and we're eating at home more than ever before. Saves money and its better for us.

Following that visit its back to Portland for a couple of days and then we'll fly back to the ATL and have our nephew Cami come and visit for a week. Following that we'll be dirt poor and need to do two things 1) Get our place fixed up to sell and 2) Head back to Nome to work some more.

We'll be in Nome for three weeks and then off until sometime in June. After the June trip it's my sister's wedding (!?) and then off to Romania with my other sisters.

We've got a lot planned. Here's hoping we can sell our place to at least save some money, if not make some money.

We were considering going to South Africa in March but we're not now. Also considering going to a conference in London in April but I don't think we'll do that either. Too expensive.

So I've given notice at both my jobs. Easy to give notice when you're an independent contractor.

Me Hey employer. I'm not available after mid-February anymore. Nice working with you.
Employer Ok. We'll miss you.

Swell hasn't quit yet but is looking forward to doing it.

Well she wants me to do it for her... via email... because she's a scaredy cat. Doesn't like to disappoint people.

Ironically it doesn't seem to phase her that by not quitting she'll disappoint me.

We're very excited that Swell didn't get sick this Christmas. We think its because we traveled a lot less than usual and didn't go out into the wild and crazy malls.

We're also very excited to go to Nome and see what that is all about.

One of these days we're going to have to settle down.

But not until Summer 2008 is over...


at the earliest.

Ignore this post unless you're family

HAPPY BIRTHDAY JDL and PA!

Hope you both have a great day and an even better year.

RIP

Destiny,
I liked it when you sat on my lap. You were too big to sit on my lap! Swell liked it when you tackled her last Christmas. She thought you were going to stop before you got to her but you ran her right over!



RIP the best big dog we ever did know. It wasn't nice of you to leave us without warning but we'll always remember you fondly.







Sorry JDL

01/01/08

Happy New Year

and if I hear one more person say Happy New Years I will scream.

My first day of 2008 will be spent working. Yippee!

p.s. For God's sake Dick Clark, just retire already.

Work Sucks.

To the dear contact lens patient I had earlier today:

Ma'am,
With all due respect I don't care what you believe.

Surprisingly beneath these rugged good looks lies someone who went to school for a couple of days to learn about eyes and contact lenses. Even more surprising is that I try to keep up with the latest studies and findings when it comes to eyes and contact lenses.

That said if you believe that my advice is wrong, fine, but please don't have the gall to say that your beliefs supersede years of research and experience. Further it doesn't have to be a "perfect world" to assume that one will wash their hands before handling their contact lenses. Also I can and do assume that patients use their contact lens solutions according to our directions.

So to repeat what I told you earlier:
1) Wash your hands before handling your contact lens (imperfect world and all)
2) Remove your contact lenses nightly (we both know you're not going to do this)
3) If not nightly (I strongly recommend nightly removal) remove them at least once a week (we both know you're not going to do this)
4) Get a pair of glasses (I know you're not going to, you know you're not going to but we can pretend can't we?)
5) Rub your lenses with the solution rather than just putting them in solution to soak overnight.


I will see you back when your already red eyes get more red. The pain you'll be feeling when I see you back will be God's way of saying; "Boy I sure created some idiots."

Sincerely,
The guy you scowled at for 20 minutes earlier this morning.

************************************************************

I saw a patient a couple of weeks ago. This poor woman is 72. Physically she looks great but mentally she's just not doing well. I don't know how dementia is measured but she is at the top of the scale.

My exam a couple of weeks ago consisted of me doing some tests and referring her out for cataract surgery.

I saw her back the other day. She had cataract surgery on one eye the day before. I was doing her one day follow up. Broke my heart when I heard this:

"I had surgery yesterday? I don't remember coming here yesterday!"

Man with her: "We didn't come here yesterday. We went somewhere else."

Woman with tears: "I don't remember going there. I had surgery!?"

That night I happened across a tv show about people climbing Mount Everest. On this show a 71 year old Japanese man became the oldest person to summit Mount Everest.

It amazes me how their can be such disparity in the effects of aging. Here I had a woman who couldn't remember having invasive surgery the day before and a man just a year younger summited Mount Everest.

I'm grateful for my good health. I complain about my back and headaches but things could be much worse. I was hit by a car with only inconvenient after effects (The backaches, headaches, and left foot problems). My brother-in-law drove my van into a moose while I was sitting in the back seat sans seatbelt (there was no seatbelt to put on) despite the van rolling on to its side I was no worse for the wear. A classmate driving in front of a speeding truck while we were in a little sporty car left me without a scratch.

Very fortunate, very grateful for my health and the health of my family.

I don't know what my point was but I felt like telling that story.