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Trainee-Authored Letters to the Editor

My First Rotation … Above the Arctic Circle

McCawley, Kevin

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doi: 10.1097/ACM.0000000000003260
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To the Editor:

“When someone invites you to hunt, you never be late.” The Iñupiaq elder’s words rang in my ears as I tugged a second pair of jeans on over my first. I barreled out of my tent and onto the 16-foot aluminum Jon boat, barely on time and hardly prepared for the next 6 hours of scouring the Ambler River for moose—or if it was Nature’s will—bear. The white fish’s scales hardened that week, a subtle preamble to the return of winter, making the success of subsistence hunting trips increasingly important for surviving another season of snow and ice.

I spent the 5 weeks between my first and second years of medical school in Alaska’s Northwest Arctic Borough, taking bush planes from one remote village to the next with a doctor who has served these communities for her entire medical career. Officially, I was there to conduct sports physicals for the village children; unofficially, I was there as a sounding board for the doctor as she weaved Iñupiaq culture, Western medicine, and tribal dynamics into each patient’s care plan.

This was my first medical rotation. It was the first time I tasted words like “lisinopril” and “metoprolol” roll off my lips, each as new to me as the muktuq (beluga blubber) and tuttu (caribou) I was offered during patient home visits. While antihypertensives followed me on my journey back to the lower 48 states, certain experiences will forever be unique to the arctic tundra—unless patients in Michigan ask me to join them in picking blueberries, felling trees, or filleting salmon.

In isolation, these Arctic experiences are fond memories and great stories, but in context, they tell the story of the medicine I provided. Combatting hyperlipidemia and hypertension included discussions about cutting back on seal oil while preparing beluga and how spicing caribou stew with wild herbs is a healthy alternative to using salt. We treated chronic back pain with ibuprofen, an ice pack, and some extra strength Tylenol, but also talked with our patients about new ways to bend while picking blueberries and how to engage their core while mushing dogs.

In my first medical rotation, I learned that caring for my patients starts with understanding who they are. While I didn’t see many zebra diagnoses, I did help hunt for the village moose.

Kevin McCawley
Second-year medical student, University of Michigan Medical School, Ann Arbor, Michigan; [email protected]; Twitter: @kevin_mccawley.

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