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 http://www.hulu.com/watch/4123/saturday-night-live-joyride-with-perot ).

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...