Wednesday, September 28, 2011

Stockdale on the Rez

Good news and bad news. The good news: After 3 days, I have a much better idea of the challenges that need to be addressed, and the job is beginning to take form. The bad news: I have no idea where or how to start. Thus, the above title (for background, see ).

In summary, a small but badly overburdened, underfunded, chronically understaffed health care facility that, within a few months, has lost a longterm very gifted and dedicated internist (married and moved down the rez to Tuba City), its very gifted and dedicated clinical director family doc (family medical leave), and a 20-year family doc. Those 3 constitute half of the permanent physician staff. Thus the entire continuing care system is under extraordinary stress. The ED is staffed by a mish-mash of contract docs who range widely in both their giftedness and dedication (several appear to have both, some neither), and many of whom are not here long enough or often enough to really learn and mesh with the rest of the clinic system to help relieve the stress.

Throw in the need to convert a paper record ED to electronic (a huge and frightening essential task), a few important accreditation issues to resolve, the need to create a good CQI system, the possibility of adding ED ultrasound and possible (one can dream) portable CT scanner, and several other priorities on top of the large-enough challenge of simply improving daily ED operations - and you've got a good-sized mountain o' trouble. Just for grins, take out of the picture the only person who really knows what's been going on and could explain (6 more weeks of leave) and you've got Admiral Stockdale at the vice-presidential debate all over again, in form of yours truly.

Just when one reaches the point of wanting to run screaming to the car to make a fast getaway (a frequent occurrence), one sees the full waiting room, the people out front, the many more sitting in their cars and trucks in the parking lots, the additional cars and trucks rolling in, and one talks with the exhausted, burned-out long-timer providers and the bright-eyed idealistic newcomers who have made the sacrifice to be here, and one must just shake one's head and get back to taking small steps in the right direction. As of today, that's the plan.

Lest anyone get the wrong impression, there have also been some very, very nice moments. I've now met and spoken with many of the staff and even lunched with another human today for the first time. Colin is a brand-spankin' new nurse practitioner (career span 5 weeks) who has made this his first job. He's a former Peace Corps volunteer (Kenya) with great dedication. His girlfriend is a nurse-midwife elsewhere on the rez, so he, too is missing his loved one(s). After work today, he, Charles (a medicine resident from San Diego), and I, scampered up The Toes (see earlier blog or Google) for a beautiful hike. I planned to take a few pics for this blog, but was sad to find the camera battery needing recharge. Yesterday, I drove 20 miles to the turnoff to the Navajo National Monument and had a very, very nice bike ride from the turnoff up the hill to the monument and back. Just what the doctor ordered. Internet (still pirated from my head nurse Keith) allows me to listen to NPR news, Skype with the fam, email, and blog (lucky you). Tomorrow eve, I hope to attend the Kayenta HS vs Chinle HS volleyball match, and tomorrow at noon is the annual homecoming parade, which passes the Health Center, so should get a glimpse ($1000 for the first place float). So, there!!

I think I have a plan for work tomorrow (one day at a time...), and then will head to Flagstaff Friday PM to fly home early Saturday. More later...

Monday, September 26, 2011

What's best?

In a happy coincidence, I happened to pick up a copy of "Zen and the Art of Motorcycle Maintenance" before leaving Claremont and heading to my new gig. 

Sitting alone on the floor of my new home-away-from-home in Kayenta, Arizona, the night of my arrival, after unloading the car, buying some basic groceries and supplies, and assembling my Ikea table, I had the free time to fully appreciate the lump of panic in my chest. A good time to distract oneself from the fear of having made a great mistake, I tried to focus on the question, "what's best", the fundamental question addressed in the above-mentioned book. (Note to readers: I'm only 4 chapters in, so it may not turn out to be the question addressed, at all, but it fits my blog plan so you're stuck with it. This sort of literary license is a genetic predisposition in my family. Sorry)

On paper, my choice to work with the Indian Health Service (IHS) has enough check marks in the “plus” column to justify overlooking some important (very) marks in the “minus” column.  Hopefully still true, but I must say that on night #1, fatigue, anxiety, and loneliness seemed to be trumping any of the noble intentions that got me here. The challenge of splitting time between Kayenta and Portland, attempting to do well at work, marriage, health, and happiness, all while doing no harm to the attempts of others to do the same is daunting. As much as I want to succeed in this, anxiety delivered an initial ass-whoopin' to confidence.

Past experiences suggest that this will all work out – lordy, I hope so. Until then, I spent my first weekend here replaying all of the “wise” advice that I’ve given my daughters to help them face significant challenges of their own. Time to walk-the-walk. If I can handle this with the grace and courage that they have shown, this should pan out. Thus spake myself to myself.

Happy to report now, after my first day at work, that I have been panic-free almost the entire day, and now that I am pirating internet access from my neighbor/co-worker, all is good. With temporary calm restored and the ability to focus on something fun, decided to drop this brief blog and introduce all to the 'hood.

To the right is the view out of my kitchen window, north,  showing my fence, a driveway, the 'hood playstructure, a few of my neighbors' homes, and "The Toes" rock formation. This area is open for hiking and mountain biking, and is likely to be the best chance of regular exercise. Not a feral dog in sight, and a really beautiful day.

Out the front door, looking south, is Sven, the road to the Health Center (3 minute walk), and the boarded-up remnants of some long-abandoned BIA structures. A fine 'hood, surrounded mostly by co-workers, many I've now met. 

I am occupying only a small part of this 3 BR house, and things are still a bit "under development". My giant inflato-bed has been great, satellite radio a blessing, and my Ikea lamp most excellent for reading. There are still patches of un-put-away stuff scattered around. It's really a fine home, although temporary, until my smaller home is refurbished.
Work day #1 was largely spent with orientation and paperwork, but got enough time to discuss things with others that I have a good start on understanding what the job will really entail. More on that as things develop, but for now I'm feeling that it will be about what was expected: big challenges, not a lot of resources, very worthy objectives. 

So, after almost 72 hours here, what's best? Even I'm not foolish enough to hazard a guess, but at 5:52 PM, Mountain Time, I'm feeling much better about being here. That said, can't wait to be in touch with y'all and to see Angela this weekend back in PDX. Meanwhile, I'll keeping reading, wondering "what's best?", and trying to sort out what in the world I’m doing here.