Sad Like Leaving Kansas

This morning I’m drinking coffee, enjoying a beautiful Spring morning in the desert with the breeze blowing in through the window.​  In a few minutes I’ll start packing up the car and I’ll be moving out of my cozy little Navajo Best Western.

I’m really quite sad to be leaving Chinle.  Sad like I was when I left Kansas.  

This was my first Indian Health Services(IHS) assignment.  When you hear people discuss working for IHS they talk about how depressing the experience can be.  I don’t know where those people worked, but I have no idea what they were talking about.  Working at the Navajo hospital here has been one of the most joyful experiences of my career. Chinle Hospital has attracted physicians of incredible quality and talent from around the country.  The hospital and clinic staff are approximately 99% Navajo and there is incredible investment into the community as a whole, and the patients are some of the most delightful people I’ve ever worked for.  

Chinle is what you would expect for a rural high-desert community.  It’s a one-horse town (it’s actually a seven horse town- those jerk horses run the place wandering through the streets wherever they want) but it lacks nothing in charm or sophistication.  There are only three restaurants, but there is always something to do, from potlucks to  yoga, trail running to ultimate frisbee.  There’s even the random dance party in IHS housing from time to time.  And if you look in any single direction you’ll see some of the most beautiful and sacred scenery you’ve ever seen in your life.  

So I’m heading out to Albuquerque for the night to visit with a friend, get the desert sand vacuumed out of the car, eat at the Frontier, and use some normal-speed internet. After those simple luxuries, it’s up to another Navajo hospital in Shiprock, New Mexico for a few weeks and then off to China.​

If you’re a physician or nurse who has considered IHS but has been scared off by people’s perceptions or comments, I highly recommend you rotate through some facilities as a contractor and get a feel for the system.  I think you’ll be pleasantly surprised at the opportunity to work with great colleagues and a wonderful patient population. 

​As for me, I’ll be back for sure.  I just have the curse of wanderlust to deal with first. 

​

GORUCK and St. Baldrick's | The Good Stuff →

tacticalstuff:

Those who where there heard my story.

Held at the Crossfit Boston gym, about 100 people (having sold out the tickets to the event, which were $10 to cover costs) gathered to drink some PBR and hear the stories of some of our best trained soldiers. Speakers, of which there were five, were a major in the Green Berets, an Israel Defense Forces recon sniper who trained American snipers in urban combat and ended up unofficially becoming a patrolling member of a Marine sniper unit in Fallujah, Iraq, two enlisted Green Berets, and an enlisted member of the 160th Special Operations Aviation Regiment (Airborne), the elite “Night Stalkers” of Black Hawk Down fame. Their stories ranged from poignant (one Green Beret’s description of a mission to rescue a kidnapped 11 year old boy named Wi’am) to hilarious (the description of shitting his pants during that unexpectedly long mission). The IDF soldier’s story of losing his brother Marines (because he did, in effect, become one of them) to a pair of IEDs, that he barely survived, was heart-wrenching, and he could not even complete that part of his War Story as it was still, after all this time, too painful for him. The stories of embedding in Afghan villages told by the major and one of the enlisted soldiers were hilariously different, as the officer talked about the positives and how he was proud of what he did, and the enlisted man discussed his boredom and the immature (his word, not mine) activities that took place during these missions. After each story, though, I felt like I, as someone who has never served in the military, had a better sense of what these men and women go through and experience, and I had a really great time. If you get the opportunity to attend one of these events, do so; it is a really, really fantastic opportunity. A lot of the money that GORUCK makes, through donations, sales, and event fees, goes to charities that work with veterans and military personnel.

hummingbird-dreams:

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for as long as i can remember, i’ve always been an advocate of 1) going with the flow and 2) staying balanced, or at least striving to be balanced. maybe it’s been a little too much jack johnson jamming or growing up near the sea, which i often refer to while writing quite a bit. i often forget that the moments i feel like i’m getting pulled under the currents and tides are in fact part of the flow of everything. i think it’s human nature to try stabilizing situations when times get rough. but by stabilizing things we defeat the point of the experience sometimes. stay with the uncertainty, dive into the unknown, it’s all about the struggle. in the act of balancing, we come alive. our sensations are thrown into a whirlpool, changing moment by moment; sometimes we feel secure and other times we feel precarious. in the long swim, we develop a tolerance for instability (and god knows that life is constantly up and down, high and low). as we come to accept this as a natural part of life, it becomes more familiar rather than frightening. Rather than fleeing from the obstacles and the oncoming waves, we grow to love the challenge, to roll and rough it out and seek standing tall on the other side. the sense of being off balance is exhilarating and reminds me of the impermanence and fragility of life and to embrace how good it is to be fully in the moment and alive.

so while i may have a bit too much of the ocean invested in my words and heart, i really believe, like surfers, that we can come to feel the power of the waves, the majesty of the elements, and a sense of our own place in this swirling universe.

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i can’t stand it- sitting outside surrounded by mountains, writing in the sun. the hobo doctor life is for me! #locumlife

Three Things I Love March 29, 2013

Three Things I Love is a working exercise in gratitude.   Each week I want to reflect on  three things I am currently in love with.  Small things like gear, a service, a good batch of beer, a computer application, a person, or a movement.  You get the idea.  Focus on gratitude.

1. Dr Zahra Shah

Zahra is a residency classmate, a friend, and a great clinician.  Currently she works as a hospitalist in Wichita, KS.

 She surprised me a few weeks ago when asking about medical relief work.  When we got down to the root of it, Zahra wanted to help out with the crisis in Syria because she couldn’t stand seeing the violence on the news or the idea of the burden on and loss of doctors in Syria.  So within several weeks she had tied in to an American organization providing medical relief in Syria.  

Zahra has just arrived in Istanbul to train Turkish and Syrian physicians in trauma management (Advanced Trauma Life Support) and then to travel to care for victims of the violence.

We’ll be hoping to post updates of Zahra’s work  on HeartHandsEyes.com in the coming week.​

2.  Sea to Summit Light Line Travel Clothesline

You can’t bring it all with you!

One of the easy secrets to packing lite is that you need to pick a simple small wardrobe that is versatile, and you need to be ready to wash it where you can- either at a friend’s washer, a laundromat or more likely in a sink or bathtub.  People think it is crazy that I do this, but if the women in Haiti can get their shirts as bright white as they are when they see me from washing in a puddle, I can do it with clean water in the sink in a hotel in Arizona or New Mexico.

Since I am on extended assignments and am a doctor I need to bring just a few more items of clothing than when I travel for pleasure.  That means when I finally get around to doing laundry I have about4-9 items to wash and dry at one time.  

I had for a long time considered the Rick Steves travel clothesline but considered it a luxury and never ordered one.  Now a travel clothesline was becoming a necessity.  I added the line to my cart but then saw the Sea To Summit line advertised at the bottom of my screen and did some research.  I watched a video review comparing the two and decided this was a a better choice for me since it had a more intuitive anchoring system and was longer which would accommodate the types of hotel rooms I usually stay in.

The nylon line (vs braided rubber) is really easy to set up anywhere in my room, and has beaded pinch points that you can use as “clothespins”.  The double line also makes it easy to hang pants or towels flat and not let them slide off.  The line also has a good built in cinch to tighten it straight.

I was worried the neoprene pouch would add bulk and weight but it does not and is super helpful in keeping the line in place.

It’s a great piece of gear that keeps me able to keep my clothes clean and wrinkle free.  You can easily make one yourself from paracord, but this just is a nice convenient option for 7 to 10 dollars.

3.  Samsara app (iPhone)

​I think everybody my age wants to or needs to improve their mindfulness, reduce their stress or introduce some kind of meditation practice into their lives.

Several months ago I got really focused on establishing a meditation practice.  I used to just guess at the time when I would sit but the Samsara app has helped me not only keep track of the meditation but also to extend my sitting time over time.

The free  app is really well designed, has a simple layout, a just does what it is supposed to do.

 You set what you need to in regards to time and chime-  both the sound of the bell (it includes one bell chime and you can pay a dollar as an in app purchase to have more but the included chime is just fine), and how many times the opening and closing bells chime.

 I really love this app and it has helped me to increase my sitting time in the morning and evening and has wormed itself to the second screen (and I have contemplated going for the home screen) of my iPhone.

 I have found my meditation practice to be one of the best habits I have introduced into my life and in 2 months I have not gone a day without meditating.  I definitely notice a difference in my stress levels, concentration, and overall well being.

Luck

“Luck is where the crossroads of opportunity and preparation meet.”

- Seneca. 

Packing Zahra For Syria

My friend Zahra ​is a full-scope Family Physician like myself who is flying out tomorrow morning to provide medical relief to victims of the Syrian civil war. Prior to her arrival in Syria she’ll also be training Turkish and Syrian surgeons in Advanced Trauma Life Support (ATLS). Since I have experience in disaster relief and mission medicine Zahra asked for some help in preparing for her mission.

I thought it would be interesting to share the gear list we prepared. The most important aspects when preparing for a trip like this is to be light and fast. You need to be prepared to move as quickly as possible, and you can’t leave your gear behind so it needs to be able to move with you at all times.

Clothing and pack color need to be subdued and not draw attention in crowds, especially as a foreign national in a war zone.

Bags

1 large duffel medical supplies (checked)

1 carry on - light hiking backpack (in neutral black/grey/light blue- no red or bright colors)

concealed passport/money pouch

Clothes

Street clothes arrival (top)

Departure clothes (top)

Jeans (1 pair)

Scrubs (3 tops, 2 pants)​

Trail Running shoes (1 pair)

sleep clothes

underwear (x # comfortable), sports bra

headscarf or Shemagh

socks x 2 (Smartwool PhD ankle socks)

long sleeve ¼ zip pullover (Patagonia Capilene 2 or 3)

thin rain jacket (Patagonia Houdini)

Electronics

iPhone (= camera, journal, language guide, med reference)

Kindle (to not go insane during downtime and long-term battery life)

headphones

usb cable for iphone and Kindle

charger

emergency usb battery pack

international adapter

Medical

stethoscope

emergency gloves

clear shooting glasses

n95 mask

Personal hygiene

small hand sanitizer

baby wipes

travel sized shampoo/conditioner/bodywash

toothpaste

toothbrush

small nail trimmer with file

small roll toilet paper

pack towel

Food/water

10 high-protein energy bars

water purification tablets

gum or mints

Medications:

Fluconazole 150mg (1)

Ciprofloxacin 500mg (20)

Flagyl 500mg (20)

Doxycycline 100mg (20)

imodium (20)

bismuth salicylate (20)

mobic or naproxen (10-30)

vicodin (6)

prednisone 20mg (10)

Personal

eyeglasses

sunglasses & case

money pouch

bandana(1)

watch (Casio g-shock)

very small compass

ear plugs (hearos)

small roll of duct tape wrapped around 3 zip ties

pen x 2

Petzl e+light

tactical flashlight

Gerber Shard keychain tool

Documents:

photocopy of medical license

photocopy of passport hidden in bag

flight itinerary hidden in bag

copies of all on iPhone

printed out map of the region and of the city (8x11)

Software/eBooks

iPhone

1.) byki Arabic

2.) English-Arabic Dictionary

3.) epocrates

4.) DayOne

Kindle

(to load on Kindle and iPhone)

1.) 2.) Turkey & Syria country guides (Loney Planet, etc.)

3.) Auerbach Field Guide to Wilderness Medicine (Kindle)

or

Auerbach Wilderness Medicine 5th Ed (Kindle)

4.) Pfenninger and Fowler’s Procedures for Primary Care

5.) The ICU Book

6.) Where There Is No Doctor (pdf)

7.) Where There Is No Dentist (pdf)

-load these in iBooks on your iPhone

I wish Zahra luck on the good and selfless work she is doing.

If she has any form of internet access she’ll send me updates and I’ll post them here on HeartHandsEyes.com

​-A

Deceptive Marketing

Yes, they really are pretending ‘Vitaminwater’ is water.  Nearly as much “sugar” as Coke, which is why they’re being sued over it.  This is especially frustrating to me here on the Navajo Reservation where diabetes cripples the community and people try so hard to make healthy choices.  

They say they are not trying to use deceptive marketing with Vitaminwater.

​What do you think from this picture?