AAPA's Annual Conference

It is nearly Memorial Day weekend, and that means time once again for the annual conference of the American Academy of Physician Assistants. This year our meeting is being held in San Antonio, Texas.

This conference offers an outstanding opportunity for PAs from around the country (and the world) to meet, network, reunite, and enjoy each other’s company, as well as to obtain a load of continuing education credits on cutting-edge topics from excellent presenters. It is also an opportunity to observe or participate in the governing process of the organization, join special interest caucus groups, and attend reunions of nearly every PA training program in the country.

PA attendance at the annual conference numbers in the thousands—usually five or six. It is amazingly empowering to be in one place with that many of your colleagues. Though our profession has grown steadily in the nearly forty years since its inception, it is still somewhat small when compared to nurses or physicians. The old question, “So, what IS a PA, exactly?” is one I don’t hear nearly as much these days as when I was a new graduate sixteen years ago; but it still comes up occasionally. For the next week in San Antonio, it is not a question that will be heard. Everybody there will know.

I’m excited to be going to San Antonio. It is my absolute favorite city in Texas, and I haven’t been there since 1989; I hope it hasn’t changed much (!). I leave Bethel tonight, overnight in Anchorage, and then fly to Texas tomorrow, arriving about 10 pm. It’s a long dang way to Texas from southwest Alaska!

From Texas I’ll head to Alabama for a week with the Triumvirate (mother, auntie, and grandmother). Gran’s health is not good at this point; she is 94, and recently had surgery from which she has not bounced back with her usual verve and alacrity. I very much hope this will not be my final visit with her, but that is distinctly possible. I’ll be back in Bethel on June 8^th; posts are likely to be scarce until then.

Happy Memorial Day to all…

New Blogger Welcome

We have a new blogger in the blogosphere, and I am very pleased that she has created this platform to share her thoughts and ideas. Those of us who are regular recipients of her letters are often inspired by them, and feel that a wider audience deserves to receive that inspiration as well.

Joyous Judy is a member of the Women's Harvest Circle whom I have never met. Last summer she was diagnosed with multiple myeloma, and due to health issues and treatment schedules, was unable to attend last fall's Harvest Celebration. A beautiful photo of her lived on the altar for those five days, and many women spoke of her so lovingly that I felt as if I knew her. She continues to face serious challenges with this disease, but her health has improved considerably, and we all hope she will be able to meet us in Montana this fall for the Celebration.

Her new blog is called Living Joyfully With What Is. She only has a few posts up so far, but I know her to be an excellent and prolific writer and fully expect that more will quickly follow. Her positive attitude glows through her words. Go. Read her. Be inspired.

Fast Break Up

Break up is the big spring event here in Alaska that says that winter is finally, truly, honest-to-goodness, no-turning-back, absolutely over. Some say jokingly that it is the start of summer, but we are actually quite a way from that just yet. The temperature this morning was about 36 degrees; it did get up to 55 by mid-afternoon, and with the sun shining brightly it felt really warm to sit outside if you could get out of the wind.

Break up is when the cubic miles of ice move out of all the rivers. Lots of variables play into when it will happen, and there are several lotteries around the state where the closest guess, by day, hour and minute, wins the pot. Those are specific to a certain river at a certain location, and are usually named “Ice Classic”.

The Kuskokwim Ice Classic terminated yesterday morning, sometime around 10 AM. I haven’t heard the official time yet.

Dutch and I were in Anchorage this past weekend (to buy our wedding rings, among other things) and on the flight home, it was easy to see from the plane that break up was getting close. All the sloughs and small shallow lakes were free of ice; the main river, however, was still solid. But the ice had dark spots where it was thinning and the overflow stains at the edges were large. I knew it wasn’t going to be long.

Tuesday morning the buzz was going around the hospital that break up was happening. I wasn’t able to get away for lunch, and after work had to race home to feed the dogs and then race to get to the City Council meeting by 6:30, so had no time to check the river. It was mid-morning today before I was able to get there, and holy cow! It was all over! A few chunks of ice are still floating down, but the river is pretty much all water now. It usually takes a couple of days for all the ice to move out; this was a really fast break up. And it looks like we’ll have no flooding this year at all.

I’m kinda bummed that I missed it. Break up is an amazing thing to watch. I’ve written about it before, here and here and here and here. The physicality of the event is what is so awesome. Conceptualize a serpiginous block of ice, four feet thick, a mile wide, and 800 miles long. That's a lot of ice. Really. A lot. As winter retreats and the weather warms up, that block doesn’t just melt; it would take too long. It breaks into huge pieces and floats out to sea, like a huge crowd of people surging towards a subway, everyone wanting to get on. Bumping, grinding, bobbing ice, in chunks as small as cars and as large as houses, racing for the ocean. Dead trees, dead animals, and all kind of debris riding on top. It truly is an amazing thing to see. People gather at the river's edge and sit for hours, just watching it all go by.

So break up for 2008 occurred on May 13^th. The most frequently occurring date for break up at Bethel has been May 18^th; it can occur as early as late April, and as late as early June. It can occur at 4:00 in the morning or at 2:00 in the afternoon. The Kuskokwim is a tidal river, and the tides have as much effect on when the river breaks as the sun does. A rainy spring can make a difference; we didn’t have one this year. This was a lucky year; it was a fast and easy transition.

What Is a Kuspuk?

Dad and Stepmom called this morning and one of their questions suggested to me that I should post a bit more info right about here, as a follow up to my previous post. “What exactly is a kuspuk?” they wanted to know. Buried somewhere deep in the archives of this blog I have mentioned it before, but not lately. So, for those who may be asking the same question, here is more about it.

A kuspuk is the traditional Yupik overshirt type garment worn by both men and women. Men tend to wear them primarily for ceremonial occasions, but for women they are everyday wear. Loose-fitting, they are extremely comfortable.

Basically, a kuspuk is a long-sleeved hooded slip-over shirt with a large pocket in the front, like a hooded sweatshirt without a banded bottom. The cuffs, pocket and hood are edged with rick-rack or a similar decorative trim. The size of the pocket and the way the trim is applied vary widely among kuspuk makers. Men’s kuspuks are solid colors, usually blue, green, black or white, and have a square bottom that ends at the hips. Women’s kuspuks are usually made from a patterned fabric, often a small floral print, and may have a short gathered skirt at the bottom. They may also be longer, essentially a dress, mid-thigh or knee length. Many women, myself included, prefer the shorter skirtless version, often known as “Yukon style.” “Kuskokwim style” generally has the skirt.

Summer kuspuks are made from light-weight cotton, and are often worn over a tee shirt. Winter kuspuks are made of heavier fabric, and may even be lined with flannel or fur. Parkas are the supreme winter kuspuks, made of heavy fur on the outside, such as beaver, and lined on the inside with flannel or sometimes a lighter fur such as rabbit, and usually include a handsome fur ruff on the hood made of wolf, wolverine or beaver.

Kuspuks are the appropriate garment to wear for any occasion, from cutting fish to picking berries to Eskimo dancing to getting married. I was delighted to have a fancy new one with lovely pearl trim for my wedding; along with my ivory ulu earrings, it was the perfect thing to wear in Bethel.

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Photos by The Tundra PA:

1. Wedding kuspuk

2. Berry Picking kuspuk

3. Everyday kuspuk

4. Pearl trim on wedding kuspuk

5. Elder in her kuspuk

Married in a Kuspuk

Today is the day for which I have waited for more than fifty years. The day that, for many years, I thought would never come. The day that, for the last four years, I have joyfully anticipated. Today is the day that Dutch and I will be married.

Our story goes so far back that there is not a time in my life which I can remember before I knew him. His name echoes down the hallways of my memory for as far back as it goes. I was three years old when we met; he was almost five. The first existing photo of us together was taken at his fifth birthday party, in July of 1955. He is the adorable boy in the white shirt at the corner of the table, third from the left. I am the tow-headed girl in the white sweater, second from the right.

The photo was taken in Heidelberg, Germany. Our fathers were both Army officers in the Dental Corp, stationed there. His dad, the Colonel, was older, and was my dad’s mentor. Our folks were great friends, and Dutch and I often played together while the grown-ups had bridge parties (for you young’uns who don’t know, bridge is a card game which was the passion of many in the pre-TV era of the 1950s).

Our moms decided at that early point in our lives that Dutch and I were meant for each other; they could not have known how right they were, or how long it would take for that rightness to manifest. I grew up with the assumption that one day I would marry him. That was just how it was.

After Heidelberg, my dad left the Army and went back to school (at the Colonel’s urging) for additional training and education to become a periodontist. We settled in Mobile, Alabama. The Colonel was a career Army man who stayed in until retirement, so Dutch moved around the US with his family as military kids do. We never lived in the same place again, but every year or so his mom saw to it that their vacation travels brought them to our home for a few days to visit. Dutch became for me this exotic, shy, ever-taller boy/young man who dropped into my quiet Southern life from places I had never been to. The first day was always awkward, but by the time he left we were old friends again and I hated seeing him go.

By high school the Colonel had retired and there was strong consideration of them moving to Gulfport, Mississippi, where we then lived, but in the end they settled in Florida. Close enough that visits continued, and throughout high school Dutch and I were pen pals who wrote letters to each other regularly. I wish I still had those letters, written in pencil on lined notebook paper.

He was a star athlete in basketball, football, and track, and sent me clippings when he made the local papers, which was rather often. Once he even made the front page of the second section when he dragged a dead human body ashore from a lake near his home; for a moment he was a shining local hero. I was quite dazzled by his deeds and prowess—not to mention his incredible good looks—and so proud that I knew him.

Upon high school graduation, he received an appointment to West Point, but chose instead to attend the U.S. Coast Guard Academy. We continued to write to each other, and when I graduated high school, I sent him my class ring which he wore on his little finger. A snapshot in one of his yearbooks shows him sitting on his bunk holding some little desk toy, and my ring is on his finger.

A huge event at the Academy each year is June Week, and his junior year Dutch invited me to come up for it. The seniors are preparing to graduate and receive their commissions, and there are lots of official events, parties, and parades.

The junior class has a large prom-style party during this week at which they receive their long-awaited class rings. It is a formal event complete with pomp and ceremony. There is a 10-foot-tall paper machae replica of a class ring through which each cadet and his date (all cadets were male back then) walked. Until that point in the evening, she had worn his ring on a ribbon around her neck; as they stop under the giant ring, she removes his class ring from the ribbon and places it on his finger. A photo commemorates the moment.

It was 1971, and at 19 I was as pure and virginal as a good Southern girl should be. Dutch invited me to bring my best friend, Jinks, as a blind date for his best friend, Claybo. The guys rented a beach cottage for us to stay in, not far from the Academy. Jinks and I drove all the way to Connecticut from Mississippi in my Volkswagen—quite a trip for two unaccompanied young women back then, and we felt quite daring.

Jinks and Claybo hit it off immediately, and I was as happy as always to see Dutch again. We had a whirlwind week of activities at the Academy, and dreamy, romantic nights at our picturesque little beach cottage. Jinks and I both gave up our virginity there, in a storybook setting, to our tall, handsome cadets who were gentle and kind and ever so grateful as they were virgins as well.

Over the rest of that year, Dutch found several opportunities to visit me at college in Mississippi, and for New Year’s of 1972 we went to New Orleans for the Sugar Bowl. At the stroke of midnight we kissed on Bourbon Street among thousands of revelers. That trip was the last time I would see him for the next 31 years.

Not long after returning to the Academy that January, he met a young woman and fell rapidly in love with her. He wrote me a long and painful letter in which he explained that he wanted only to be with her. In October of that year they were married. I was devastated. I never answered his letter, a childish response which I now regret; he deserved more from me than silence.

Over the years I thought of him frequently and wondered how he was, how his life was going, if he were happy. Our parents continued to exchange Christmas cards, but his mother became very circumspect about mentioning him. I knew when his two sons were born, but not much else. I tried several times to contact him, but never with any success. He has been my soul mate since we were children, and I never stopped wanting to know of him, to keep a connection of some kind.

In the summer of 1983 we almost saw each other. A family vacation took us through the town where his mom lived (the Colonel had passed away by then) and Dutch and his family lived nearby. Of course we stopped to visit his mom, and she called him to let him know and invite him to join us. He very much wanted to, but declined for the sake of maintaining peace on the home front. I was incredibly disappointed.

Life continued to chart our paths in separate directions. He completed 24 years as an officer in the Coast Guard and retired at the rank of Captain. He was living in Houston, Texas, and moved on to work with an engineering company that builds off-shore oil rigs in the Gulf of Mexico. His sons grew up and the oldest chose to follow in his dad’s footsteps, graduating from the Coast Guard Academy in 2000. He is now in law school, and continues to make his dad proud. The younger son graduated from college in 2006 and is not yet settled on a career path.

I, meanwhile, moved from college in Mississippi to California for a few years and then to Seattle; completed a Master’s in Public Health at the University of North Carolina at Chapel Hill and then returned to Seattle to complete training as a physician assistant at the University of Washington Medex NW PA training program. My work as a PA took me to a migrant farmworker clinic in central Washington, then to Spokane, to Montana, and eventually to Alaska where I have been for nearly ten years.

In the summer of 2003, I received an email out of the blue from my old friend Jinks. She found me through the internet and we began writing. She mentioned that she had also found Claybo, and I was stunned. I knew that he would know where Dutch was and how to contact him. I wrote to him, he wrote to Dutch, Dutch wrote back to him, he wrote back to me, and eventually, I wrote to Dutch. That was the beginning of the most incredible year of correspondence in our lives.

Our connection as soul mates was still there, and immediately apparent, after all the long years of silence and separation. We wrote to each other daily, we talked about everything; we fell in love again through our writing.

The following summer he left his life in Houston and moved to Bethel to live with me. We rented a motor home and drove the Alaska Highway for two glorious weeks, from Seattle to Anchorage, and then flew out to Bethel. And here we have lived most happily ever since. He adapted quickly to the cold climate and has become an avid snowmachiner. He loved driving his own dog team in the Arctic. He doesn’t even mind shoveling snow.

Dutch is my soul’s true mate, and the love of my life. I feel incredibly fortunate to have known him for as long as I can remember. He is one of the finest men I have ever known, and I will be honored to be his wife.

Our ceremony (in about an hour!) will be brief and private, with only two witnesses in front of a Justice of the Peace at the courthouse. And I do plan to wear a kuspuk; a lovely new one made for me by one of the physicians at the hospital (thanks, Dr. R!). The whole wedding-gown-thing seems somehow not appropriate for me, for here, for this. There will be no flowers, as Bethel doesn’t have a florist. We don’t have rings yet, as Bethel doesn’t have a jeweler. I won’t wear make-up; I don’t even own any! I won’t get my hair and nails done, and there won’t be any bridal showers or wedding gifts. For us, for here, a kuspuk is perfect. In my wildest childhood dream, I would never have imagined it.

Happy Birthday, TMD!

Today is the two year blogiversary of Tundra Medicine Dreams! It amazes me to think that I have been writing this blog for two full years; it just doesn't seem that long. This makes the 234th post, which is about one every three days. Just recently the 100,000th reader visited.

Of all the posts I've written, the one that enduringly gets the most visitors--through Google searches--is the one on huffing. The search strings vary a bit, from "how do I get high on Axe deodorant?" to "how can I tell if my child is huffing?" Probably the second most popular is the post on breastfeeding, landed on invariably from a search on "oldest breastfed child." Interesting how much people want to know that (my answer: the oldest I have personally found was seven years old). Coming in third would be the post on diet and obesity among the Yupik Eskimo people.

Controversy has not had a high profile here, and subsequently I have not garnered a lot of comments. Most posts get only three or four. The big winner was the one time I hosted Grand Rounds, in September of 2006, which got 32 comments--most of which were "thanks for including my post." That was also my all-time high number of visitors in a single day, nearly 700 as I recall. Second place in the comment division went to the post on a village funeral with 18 comments. Even though I feel like an old-time blogger after two years, I still get a thrill when people take the time to leave a comment.

I started this blog out of a desire to share with people the breathtaking and sometimes subtle beauty of the Yukon Kuskokwim Delta, and the stirring and generous warmth of the Yupik people. It has been an enriching experience for me, and one that has brought me much joy. To those who have become regular readers of Tundra Medicine Dreams, thank you for sharing this journey with me. And to those who have left comments, quyana cak nek!

Jody's Trials

I have the most amazing friend. Her name is Jody Drew and she lives high in the mountains of New Mexico. She was one of the Arctic Adventurers which I blogged about last month (scroll down if you missed it); she was nicknamed “Mackenzie” on that trip.

Jody and I have been friends for over a decade, we think going back to about 1993 or ‘94, though neither of us can remember precisely when we met. Probably at the first or second Women’s Harvest Celebration I attended.

From the start, I was quite taken by her gift with words, both written and spoken. She has an ability to see right to the heart of the matter, and to speak to it with such clarity that the issue (whatever it is) comes into focus for others who often have an “aha!” moment. She frequently uses metaphor with delicacy and precision to achieve such moments.

She walks in the world with a heart full of compassion, eyes that see the details, and hands that give kindness. She has a strong, fit body, boundless energy, and infectious high spirits. She is an incredibly fun companion, and I was so very glad that she went to the Arctic with me.

Jody has been a high school teacher for all the years that I have known her. The delight and respect with which she speaks of her work and her students make me wish that I had been blessed with such a teacher at that formative stage of life.

For the last several years, Jody has worked as principal and teacher at a bilingual Charter School, which she founded. Her commitment to the school has been absolutely unwavering, and her considerable talents and energy focused on the school’s and the students’ success. She has believed from the start that the school was achieving its goal of creating a new and involving experience of education for its students.

Jody returned home from our trip to the Arctic to discover that in her two-week absence, several current and former teachers had gone to the school’s governing council to complain of what seem to be minor details about her management style. She did not know exactly what they had complained of, but found that she had been put on administrative leave indefinitely—not allowed to run the school or to teach—while they investigated. She had no idea what they were investigating, and was given no opportunity to respond to any complaints against her. An article about her, which appeared in the Santa Fe newspaper, gave her more information about what was going on than the governing council gave her.

That article is linked here. As I read it, I kept thinking that it did not sound at all like the person I know Jody to be. And I wondered what the hidden agenda was of those doing the complaining.

The governing council sent out a letter to the parents of the students of her school, saying only that Ms. Drew had been removed from her duties due to “serious concerns” on the part of the council. They did not specify that their concerns were related to management issues, opening the door for misinterpretation that their concerns involved sexual misconduct with students. Her professional reputation as an educator would be totally trashed by such a misinterpretation.

To top it off, she learned a week later—again by reading the newspaper—that she had been fired. She was never given an opportunity to answer any allegations, or even to know exactly what they were. And she was not informed of the governing council’s decision by the council itself, which seems incredibly cowardly.

As if the universe had decided that all this were not enough challenge for Jody, she also arrived home from the Arctic to find that her beloved dog Faith was very ill. She had, and soon thereafter died of, lymphoma. So there was at times overwhelming grief stirred into this mix of emotions resulting from the issues at the school. It seems almost too much to bear.

I never met Faith, but I felt almost is if I knew her from the poem Jody wrote in memory of her. It brought tears to my eyes when I read it, and does again now just thinking of it. She gave me her permission to post it here.

Faith,

Past tense

I didn’t like her at all

when I got her.

Sojourner, just two days underground

back of the patio,

under the juniper.

who was my fierce companion

sat in the bus,

slept on my feet,

good manners,

after a difficult beginning.

I thought I wasn’t ready.

But, Carly, crying

at school on Monday

“You have to take my puppy

We’re moving,

My Dad’s gonna kill her!”

I can’t.

Not, yet.

But,

What kind of dog?

“cattle dog”

Uh-oh, right kind,

What’s her name?

“Faith”

So, home she came.

All 6 or 8 years old of her.

All 50+ pounds of prime Alpo fed of her.

All chatty, talking

shovel-headed

insisting to sit right on top of me,

all the time of her.

And I did not like her.

At all.

And she, ran with the horses

5 hours that first ride.

Yelped a bit coming through barbed wire,

stumbled a little,

and ran with us,

on the horses.

At the end she had

cholla,

one huge mass

on her chest.

When I pulled it off, I noticed

pink.

And found her chest ripped

almost off,

chin to belly,

one big flap.

The fence had come in the first five minutes,

and she ran with us,

on the horses,

smiling the whole run long.

She was crazy for balls.

Tennis balls on the run or high bounce.

Soccer balls stolen,

and had the craziest repartee with a basketball

bounced off her nose, run, herded rather, in wide circles,

back to me,

panting, and demanding more.

She came with two good eyes.

Lost the one to a terrific toy.

A rigged up launcher,

that used to throw clay pigeons,

for skeet shooting.

Hundreds of balls,

launched down the drive,

deliriously happy Faith,

launched after them,

returning them to me,

demanding more.

The fragile limbs of visiting kids

had my attention more than she,

and I didn’t notice

she’d switched sides,

and launched

exactly when the steel spring did.

It caught her eye exactly.

She whimpered once,

then followed me into the house for a cookie,

and an ice pack.

And the weeks long gore

that followed.

Biking to Our Lady of Light

for plastering

on the road,

going fast.

Those three, stealthy Shepherds

caught her.

she wasn’t beside me and I wheeled back.

Tossed dogs and screamed for the owner.

Who obliged with a ride to the vet.

My fist clenched on her brachial artery.

Spurting crimson.

3 hours there, and the vet said, “oh shit”

because nothing looked good, at all

not noticing that I was still there.

Still holding pressure.

She lived.

Walking back from downtown,

before sunrise

dusty, too hot already, June

She bolted for a rabbit,

on Sam’s hillside.

Followed it into, and out of a bush.

Was followed by two coyotes,

who got her, over the ridge.

Me running, whistling,

calling like crazy.

She came back,

limping

on a leg,

bit through,

licked me like “sorry”

and headed home.

And all those kids at school.

Carly’s class.

many after.

Hot pockets and burritos, and

barking down the halls at running kids.

on the bus for field trips.

On the tables

for comfort.

Under my desk.

Under my table,

late nights,

working.

Insisting on a walk.

Demanding dog food 5 o’clock.

Every morning hello.

Every morning, what shall we do.

Every morning and all day long,

into many, too many late nights

there.

Under foot, under arm,

at my back in bed.

Shovelling under my hand,

flying monkey screaming,

and nibbling on me,

every night.

Lymphoma got her

finally, today.

Helped out of her bag of bones

by Murt’s gentle needle.

She’d been awful, all day.

Panting, uncomfortable.

Around 5, she tried to get off the couch.

I lifted her.

And she walked, wobbled,

out the front door and

down two steps,

to the dirt above the orchard.

Emily came.

requisite bottle of port .

And we sat with her.

“Murt’s coming to help you out of this mess,

but you can go now, if you can”.

She lurched up, and tottered into the orchard

to shit, under the honeycrisp.

Then, looked her one eye at me,

I carried her back up.

That unknown yellow dog came by,

as he does most evenings,

and peed on Faith’s spots

and scrapped the dirt.

She’d usually run him off.

Just lifted her head and looked, tonight.

Murt came.

Karen came and hugged me tight.

A tiny drop of barbituate.

“She’s already gone”

Carried her inside.

Wrapped in a flannel sheet.

She’ll keep in the living room

until tomorrow morning.

With sun up,

Karen will come again,

with shovels,

and we’ll dig deeply enough

to prevent the coyote’s feast,

again.

-Jody Drew

28 April 2008

So many people in Jody’s situation would founder in the anger, resentment, disbelief, betrayal, desire for revenge, and hurt feelings that naturally occur in response to the treatment she has received from the school she has put so much of her love and hard work into. I do believe she went through all those emotions, but in the end, as she so typically does, she sees the situation as part of a greater good. The council, parents and teachers are pulling together to take the school in a new direction, with new commitment on all of their parts. And Jody suddenly has a whole new future to create.

I, on the other hand (being somewhat less high-minded), see this as an unbelievably wrongful termination, and hope that she successfully sues the pants off them and receives a very large settlement for her mental anguish and the destruction of her career and livelihood. I know that whatever she decides to do with the rest of her life, she will bring many gifts to those fortunate enough to know her. I am blessed to be one of them.

First two photos of Jody in the Arctic by The Tundra PA. Photo of Faith licking Jody’s chin by Dominique Revelle, used with permission. More of her photos, including another one of Faith, available on Flickr at lamygrrl.