Well, I can't let this pass...
This is an example of "you can take the boy out of the country, but you can't take the country out of the boy..." Having moved from one edge of civilization to another has brought with it all sorts of revelations and wonders. For example, the Northern Marianas is a US territory, but lots of neighboring islands are not. Which means referral ability is greatly a function of citizenship.
We currently have a patient who was found to be in complete heart block. The closest cardiologist is in Guam, about 100 miles from here, but the patient did not have a passport. Also, we do not have a medivac service, so all medical transports have to go on a regular scheduled flight by buying 6 seats and folding them down to accommodate a stretcher. So, while waiting for the bureaucracy to get its act together to get an expedited passport we arranged for the hospital in Guam to send a temporary pacemaker and lead which one of my colleagues managed to float into place. While still waiting, all of a sudden the pacemaker lost capture, and it was discovered that the wire had been cut during a dressing change. Since that was our only wire, my colleague ran home, got his soldering iron, and managed to solder the leads back together, without removing the wire. It is now about three weeks, and still no passport.
Practice in Alaska prepared me very well for practice here, and stories like Boondock's happened often enough to make life there an adventure. I love both these lives. Every day is going to work, and getting to "improvise, modify, and adapt." I can't believe they paid me to do what I did in Alaska, and can't believe they are paying me to do what I do here.
