What a week it has been! First I arrived with my parents to help settle me in to Seattle. That was a blast. The house was a bit more like a fraternity than I had imagined and twice as messy. We went to and fro buying up all the necessities. THANK YOU MOM AND DAD!!! Once they left I began, what seemed to be, the impossible task of cleaning up the house. Though messy, though only 2 bathrooms between 10 people, the location and scenery are incredible! I am only a 5 minute walk to class and I we are surrounded by the lake on three sides.

Orientation was much more fun than I had imagined. We kicked off with a sports competition with the whole class and my team won! It was awesome. We continued with some normal lectures and just wrapped up yesterday.

Today I parked cars on our front lawn and made $600 (I got to keep 10%). This is how the house makes money. Then I went to my first Husky game and it was spectacular! I love going to a school with a football team. I hope you enjoy the video and the pictures!! Stay tuned....

Hiking up Deer Mt. and camping at the top was so much fun! I went with one of my best friends, Tara Miller. We each packed way too much up the trail and it was easy going for most of the way up. Tara packed an astounding 50 lbs up that mountain and once we reached the top it was a bitter cold rain storm and some hiking through snow. But we eventually made it to the little cabin at the top and to our surprise there was a little oil heating stove which dried us out and kept us warm for the night. Newt loved the hike and was exhausted when we returned home. I could barely feel my legs and back the next morning because they were so stiff. Then a quick float plane trip back to Met for work!

Monday was another great day at the clinic. Spencer is no longer here so it is just me. I have found that going in and interviewing patients without someone to fill in the blanks is harder than I thought. I find myself asking all the questions without direction. It is a little terrifying because I am constantly reminded that I have no idea what I am doing. Luckily the staff here is amazing and when I come out with only a line or two of information to share they take the time to evaluate my performance and give me great feedback Dr. Crosby is gone and a new doctor Dr. Ratlif is here. I have met her before and she is great. Currently I am following Dr. Henry around and he has been great as well. I think the nursing staff is warming up to me because the nurse director stopped by my house and dropped off a few jars of kippered sockeye salmon and twenty pounds of fresh caught King salmon from her husband’s boat. I was also invited to watch the native dancers practice dancing in the long house in preparation for this weekend (Founder’s Day in Met). They invited me onto the floor and they showed me some of the traditional moves and I got to dance with them on the main floor. It was AMAZING! I took call with Michele and we only had one call in the afternoon (Yay!). She is the one that calls pretending to be the patient and I have to triage her. I can’t help but feel this growing terror of becoming a physician; there is so much to know, so much responsibility, and such disastrous consequences. I have been chatting with Dr. Henry (a young doctor from New Mexico) about residency and he has been sharing some horror stories.

The time has arrived to hit my project hard and fast. I have decided on and been approved for a community garden project. Today I spent most of the morning in a meeting with a master gardener interested in the project. She gave me a list of some “heavy hitters” in the community to call and invite to a meeting. I call them all and most said they would be thrilled to hear us out. The plan is to put together a proposal which would include funding, staffing, mission, and general organization as well as literature backed research demonstrating the positive effects of gardening on childhood obesity and adult diabetes. If these community leaders agree to the project then we will write it up this weekend and they will present it to their groups next week. Everyone is excited about this project and after looking over the grant I am in for a long weekend of grant writing (which is the part I committed to doing). I hope this all works out. I can’t wait for this weekend because the clinic director’s daughter is getting married (HUGE DEAL), a potlatch, and Founder’s day!

Weddings, Potlatch, and Catheters

What a week! So the clinic days have flown by. One day in particular sticks out because I was able to put in my first urinary catheter (under great supervision of course) but it was all me and I have decided to avoid getting one myself at all costs. We had few interesting emergencies and some great cases as well but this weekend was the best I have ever had in Met.

Mike and Michiel's wedding.

Michiel is the daughter of one of my FAVORITE people in Met. She is the clinic director and is like the godmother of Met in my opinion. She is well respected and has done great things in the community, so when it came to her daughter's wedding it was referred to as "the wedding" rivaling the royal wedding in notoriety. It was a glorious celebration set against an unbelievable mountain/ocean back drop with a perfect fusion of tradition and modern protocol.The bride was stunning and her husband-to-be was a tall and stern looking native man. As a couple they looked amazing. After the wedding we all went to a sit down reception and listened to many praises from both sides of the family and were all invited to the wedding potlatch to take place the following day.

The Potlatch

Never in my life have I seen such a celebration. For those of you who do not know what a potlatch is; it is a celebrations for the whole community with traditional food,

native dancing, and ceremonial gift exchanges, speeches, and thanks are given. As Michiel (a PhD candidate in native culture studies) explained, the main purpose of a potlatch is the redistribution and reciprocity of wealth (gift giving). When I arrived there were a few presentations from the newly weds then the feast. And what a feast it was! Long rows of tables were set out for all of the guests, hundreds of seats.

Then servers (who were all relatives in some way or another to the newly weds) came out with plates stacked high with dungeness crab (the best crab in SE Alaska in my opinion), traditionally smoked salmon that knocked my

socks off, fried uligan fish (This was the first time I tasted them after hearing from several locals that it was an "acquired taste", I loved them), deer soup, salmon eggs and seaweed over rice, and herring eggs that came on a hemlock branch. Such an eclectic array of tastes and textures as I have never experienced before.

I was eating wildly and laughing with the

elders sitting near me as they were amazed to watch me devour any and all extra crab/fish/anything put before me. What a feast! Then we cleared the tables and awaited eagerly for the dancing.

When I say that "I have never seen such a celebration before" I m

eant it, during the "opening ceremony" all of the dance groups came all at the same time. This meant that all of the drummers were drumming which shook the building to its foundations and filled the hall with a thunderous noise that would put jumbo jet engines to shame. The only thing that vied with the mammoth sound came from the dancers themselves. Both men and women chanting and singing deafeningly loud, the men with their deep and fierce roars and the women overtop with their majestic and bold tones.

Now I must admit that I assumed that potlatches lasted only a few hours, "you get in, you eat, you watch some dances, you leave how long could it take?" Little did I know that potlatches are long events. We started at 1pm and didn't finish until 3am! I am proud to say that my family stayed the whole time. We received some spruce tip syrup, native art, and much more. All in all it was one incredible party!They came in a line and slowly filled the hall until every inch of the dance floor was covered. It was truly a sight to behold (see video http://www.youtube.com/watch?v=FoZeoxj_zbU, though it doesn't do it justice). Throughout the ceremony there were several dance groups that came out to perform and they were each spectacular! A few times I even got up to dance and I have to say it was interesting being the only "white guy" dancing but the community members were great and showed me what to do (while laughing at/with me the whole time). My most memorable moment of the evening was when they called all of the single men up to dance and some of the female dancers I was sitting with encouraged me to go up. So there I found myself with 4 other impassioned and strong looking male dancers feeling very out of place and nervous as ever because I have no idea what to do.

One of the dancers came out and showed us what we were to do which was looked like a turkey dance to impress and seduce the women. Once we started the whole hall erupted with laughter at the sight of these young men "shaking their tail feathers" on the dance floor (see video http://www.youtube.com/watch?v=EQ-3ULonE0o). It was a riot! My mother at one point was called up to receive a gift (a hand-painted native drum!) for giving up her house and leaving her son "out in the cold" for the wedding party. She was blown away. It was a magnificent drum. Finally the night ended around 3am.

The next morning was Founder's day for the island and I ran the "marathon" which was only about 4 miles. I cam in near last (boy do I need to get out more). There were booths and food for the community members and that night I went out to see the fireworks. It was a funny experience because in Met they didn't have all of the fireworks ready like other cities, they had to bring them out to the shooting zone in loads so we would watch 5 mins of fire display then have to wait 15mins for them to go get/set up more all the while the locals were shooting off their own impressive collections. What a trip!

Met week 3

Hiking up Deer Mt. and camping at the top was so much fun! I went with one of my best friends, Tara Miller. We each packed way too much up the trail and it was easy going for most of the way up. Tara packed an astounding 50 lbs up that mountain and on

ce we reached the top it was a bitter cold rain storm and some hiking through snow. But we eventually made it to the little cabin at the top and to our surprise there was a little oil heating stove which dried us out and kept us warm for the night. Newt loved the hike and was exhausted when we returned home. I could barely feel my legs and back the next morning because they were so stiff. Then a quick float plane trip back to Met for work!

Monday was another great day at the clinic. Spencer is no longer here so it is just me. I have found that going in and interviewing patients without someone t

o fill in the blanks is harder than I thought. I find myself asking all the questions without direction. It is a little terrifying because I am constantly reminded that I have no idea what I am doing. Luckily the staff here is amazing and when I come out with only a line or two of information to share they take the time to

evaluate my performance and give me great feedback Dr. Crosby is gone and a new doctor Dr. Ratlif is here. I have met her before and she is great. Currently I am following Dr. Henry around and he has been great as well. I think the nursing staff is warming up to me because the nurse director stopped by my house and dropped off a few jars of kippered sockeye salmon and twenty pounds of fresh caught King salmon from her husband’s boat. I was also invited to watch the native dancers practice dancing in the long house in preparation for this weekend (Founder’s Day in Met). They invited me onto the floor and they showed me some of the traditional moves and I got to dance with them on the main floor. It was AMAZING! I took call with Michele and we only had one call in the afternoon (Yay!). She is the one that calls pretending to be the patient and I have to triage her. I can’t help but feel this growing terror of becoming a physician; there is so much to know, so much responsibility, and such disastrous consequences. I have been chatting with Dr. Henry (a young doctor from New Mexico) about residency and he has been sharing some horror stories.

The time has arrived to hit my project hard and fast. I have decided on and been approved for a community garden project. Today I spent most of the morning in a meeting with a master gardener interested in the project. She gave me a list of some “heavy hitters” in the community to call and invite to a meeting. I call them all and most said they would be thrilled to hear us out. The plan is to put together a proposal which would include funding, staffing, mission, and general organization as well as literature backed research

demonstrating the positive effects of gardening on childhood obesity and adult diabetes. If these community leaders agree to the project then we will write it up this weekend and they will present it to their groups next week. Everyone is excited about this project and after looking over the grant I am in for a long weekend of grant writing (which is the part I committed to doing). I hope this all works out. I can’t wait for this weekend because the clinic director’s daughter is getting married (HUGE DEAL), a potlatch, and Founder’s day!

2nd week in Met

This has been another interesting week. I volunteered to be on-call everyday, which in hindsight might be a mistake. During the day I am seeing patients with Spencer, the other medical student, he is showing me the ropes and is great because he understands my level of knowledge and really goes out of his way to explain things. We go in, interview the patient then present to the physician. Next we all go in together and treat the patient. Afterwards I have an opportunity to “debrief” with the physician, which entails asking any questions or making any comments on how everything preceded. Last night I was on-call for the first time and discovered that my “black cloud” has followed me from Boston because we had a call about once every hour or two. I saw a gambit of patients. I got to put in an IV and monitor various patients (supervised of course!).

Tonight I am on-call again but this time the on-call supervisor is going to triage the patients then call me as if she were them (regardless of the complaint ie: “my kids are being too loud what do I do?”) and I have to respond as if I were the on-call doctor and would have to triage them myself. I have already had my first call and it was funny because she only gave me the information she received which was not much and did not make sense. This patient I decided that they should stay home and not come in and she agreed and had already told the patient the same thing. Did I mention that I love it here?

Metlakatla

I arrived in Metlakatla (Met). Well, perhaps I should describe how I did this. I flew, via jet, in to Ketchikan’s airport on an island across the channel from the main city. After taking a ferry across I walked down a few blocks towards Taquan Airways, all-the-while float planes were buzzing around like mosquitoes, bald eagles were perched everywhere watching vigilantly, and whales had been spotted coming down the channel. I reached Taquan and clambered into a small four-seated beaver (that's a type of float-plane for those non-Alaskans) loaded down with US post. We taxied out on to the water and waited for the “traffic” to clear before the roaring engine took us into the air. Soaring high over the channel I saw the whales and before I knew it we were touching down in Met. Met is a small community with just over a thousand residents and it shows. As I walked towards the clinic everyone passing in their cars gave me a friendly smile and a wave. I reached the clinic and was immediately thrown into mix. In fact, a nurse came over gave me an oral report, handed me the patient’s chart, and walked away. I chased after her and explained how it was my first day and I would love to treat the patient with someone in the room with me. She smiled and assigned me to one of the health care providers and I followed Michele for the rest of the day. Michele is a PA and she was AWESOME! She explained her thought process as we proceeded and answered every one of my questions. It was a fun experience.

The next day I shadowed Dr. Crosby, an elderly gentleman from S. Carolina with an accent to prove it. He is the type of physician I strive to be. His patients love him, his co-workers admire him, and he is insanely smart. There is another 4^th year medical student here, Spencer, from Harvard and he is teaching me a TON! We go in together to see each patient and I get to do the interview and any questions I forget, he asks. Then we do the physical exam and present to the physician. It is the perfect set up. But today I only saw 2 patients before we had an emergency. An elderly gentleman came in with symptoms of a stroke. I almost got to put in an IV and everyone was running around like crazy. It turned out to be a game of “hurry up and wait” because the patient had to be transported to Ketchikan via boat and the boat was not ready. After 40mins of waiting we wrapped up the patient and took the 30min ride to Ketchikan and handed him over to their staff. The rest of the day we wondered around town and waited for them to fuel up and get some other business out of the way. I am hoping that someone will take me fishing while I am in Met because the weather is unbelievable. Stay tuned for more and photos!!

Oh Canada..

So I arrived in Canada a few days ago and I am slowly falling in love with this city (Vancouver). I am staying with Lidia at her host family's house and they as super nice. They are a Philipino family and they are falling head of heels to cook me traditional food (I may have mentioned that I love lumpia, shanghi, and more). Our first day out Lidia and I explored downtown Vancouver. This town is built for pedestrians. We walked for hours ducking into the various retail stores because they are all having mega sales 70% or more off of many items. I took advantage and bought a few things but then later found out that there is a 12% tax here!!! Damn. We are eating like kings and just having the time of our lives. The International Jazz festival is going on while I am here so we've been chasing jazz venues for the past couple of days. I am helping Lidia with her English and she is excited to start classes next Monday. Our first day ended with us having front row seats to a jazz concert splitting a bottle a decent wine. Jazz, wine, and good company does life get any better?

Day two we set out towards the waterfront, Gastown, and Granville Island. The waterfront was nothing too spectacular although Lidia enjoyed seeing all of the float planes and ships in the harbor. We walked through Gastown and saw the giant steam-powered clock. I love Gastown and hope that we return there at night. It is a cute little street with fashionable stores, pubs, and more. There was another jazz concert there that we sat and watched for a while before heading off to the island. So far my favorite place in Vancouver is Granville Island. It reminds me of the market in Boston Fanull Hall (sp?). There are all sorts of foods, artisans, and more there. We just had a ball walking around and sampling some of everything. We took the aquabus to get there and I think we may return tomorrow. After Granville Island we left for Vanier Park where we thought there was a Shakespeare festival but it turned out to be just a theater. We relaxed in the park before our long trek back to her host family's house (across town, 30min subway trip, 15min bus trip). Rain or shine we have been walking machines and it is a good thing too because Lidia's host mom constantly bombards us with food. 'You too thin. Eat! Eat!'. 'That is not enough make it a dozen or better a baker's dozen'!