Category Archives: Anchorage

ICU at ANMC in Anchorage in June

Anchorage, Alaska. Home to bears, moose, liver dialysis and abundant subclavian central venous access. I chose to spend all 4 weeks of the rotation in the ICU and would definitely recommend the experience (although I hear that residents enjoy their time with all specialties up here).

At ANMC all critically ill patients end up in one unit under the care of the ICU team, so you will see patients admitted with trauma and other “surgical problems” (NSTI, ICH requiring craniectomy etc.) in addition to the things we are more used to managing. If the variety doesn’t interest you it’s possible to pick up only the more classic medicine patients, but you will at least have the opportunity to manage a broader spectrum of critical illness. You will probably get to do lots of procedures (all manner of central lines, bronchoscopy) and intubate relatively often if you are so inclined. A more unique thing you will see here is MARS “liver dialysis” which gets used for acute liver failure and Tylenol overdose. The attendings and other hospital staff are very friendly and a lot of fun to work with.

At least in the summer there is lots to do here, four weekends is just not enough time to see all the cool stuff in the area. The hiking/wildlife is incredible. Homer and Seward make great weekend trips. This also seems like the place to be if you like fishing.

real sign at Kenai Fjords National Park
if this kind of bear attacks you, fight back
If this kind of bear attacks you, only fight back if it literally starts to eat you
seriously though, get bear mace if you are going to be hiking here in the summer
moose chowin’ down at Kincaid park

ANMC/Anchorage!

I spent May 2017 in Anchorage and had a great experience at ANMC. I ended up only having 3 weeks there and did 1 week in the ICU, 1 week in a mix of clinics (Rheum, Endo, Pall Care) and 1 week of ID consults. In general if there for 4 weeks I’d recommend 2 weeks in the ICU to get the hang of it and a range of experiences and I think the staff there prefer it for some continuity. Schedule in the ICU was M-F 7am to 7pm for sign out (able to leave early some days). I worked with Dr. Worth who is great and trained at UW! I also really enjoyed the clinic experience – great way to learn more about the native health system and how subspecialty care is delivered to such a broad geographic area. Great teaching too and pretty relaxed schedule. Lastly ID consults was great with really interesting cases and fun attendings who love to teach. I was initially given a pretty short list of options of what to do but when I got there but I found that people were happy to have me in most clinics and if you ask they will make most things work.

As far as Anchorage itself it’s a very livable small city and easy to adapt to quickly. People at the hospital were all really welcoming and eager to provide recommendations for what to do and see. May was a fun time of year there as spring was really just starting but days are long. Be sure to check if hikes in the area are still icy/snowy! For housing AirBnB worked well to find a spot – midtown isn’t the most attractive part of town but halfway between downtown and ANMC. Start housing search early if you want to do a monthlong rental especiall in summer/spring. Enterprise renal car through UW also very easy to do.

I loved visits to homer (halibut fishing!), seward (kenai fjords tour/kayaking), hikes around anchorage (power line trail, eagle river nature park, flat top).

Portage Glacier Hike, at end of Whittier Tunnel
View of Anchorage from Earthquake Park
Otter enjoying Seward!

 

 

 

ICU at ANMC in Anchorage, AK!

Let me start by saying that if you’re reading this and are already scheduled to do your WWAMI rotation at ANMC though haven’t yet submitted your Alaska resident license application…stop reading and go do it. For real, you’ll thank me later. Getting that beast of an application out of the way about 4-6 months ahead of time will allow you to cruise on up to Anchorage stress-free knowing that you’ll be all set for your rotation!

Anyway, with that said, I spent my entire month of March in the ICU at ANMC and as those before me have already said, this was absolutely one of the best experiences that I’ve had in residency! As the only resident in the ICU, everyone is super willing to give you procedures and the attendings are all excellent teachers. By the end of the rotation I had done about 10 central lines (mix of IJs and subclavians), 2 intubations, 3 bronchoscopies, many arterial lines, and even a handful of chest tubes! Overall, you get a ton of autonomy and really feel like you are the primary provider for your patients, while the attendings are always available for guidance. The staff at ANMC are awesome and the ICU nurses in particular are very knowledgeable and always willing to help. From a cultural and systems perspective, working at ANMC is also really interesting as it serves the Native population not only in Anchorage but from all around Alaska. Many patients are flown in from various parts of the state, including Little Diomede, which is the westernmost island of 110 people that is right on the US/Russia border in the Bering Sea! The ICU itself is about 20ish beds, and they’re actually in the middle  of some construction to expand it. The acuity of patients ranged quite a bit, and we certainly had some sick folks with interesting pathologies.

As far as Anchorage goes, it’s not a very big place but definitely has a lot going on! If you’re heading out in March, I would recommend catching the start of the Iditarod. Overall it was pretty darn chilly with temps in the negatives most of the month until late March and snow/ice pretty much everywhere. I stayed in an apartment close to the hospital and got around just fine in my trusty Ford Focus rental car, though there were a couple of hefty snow storms and those not used to driving in the snow might feel better with a 4WD. Otherwise it was awesome exploring the city and surrounding area. Check out the pics below!

Start of the Iditarod!
Resting up before the big race.
The Diphtheria antitoxin is on its way!
I thought the thermometer would stop at 0, but apparently it goes into the negatives…
Flattop mountain just outside of Anchorage. ‘Murica!
Skiing at Alyeska in Girdwood, just 45 minutes outside of Anchorage.
Denali on a rare, clear day.
Walking across Portage Lake to Portage Glacier.
Portage Glacier
Found some old skates at a thrift shop and got in on some pond hockey!
Pond hockey after work.

 

ANMC, Anchorage

I highly recommend the ANMC rotation, as so many others before me have! It’s a fantastic clinical experience, and there are endless outdoor activities in and around Anchorage. Amiko Uchida and I did this rotation in April at the same time, which made it extra fun.  Spring in Alaska can be unpredictable (it’s historically rainy, muddy, and cold), but we lucked out and had snow in the mountains during our vacation week at the beginning of the month, and mostly clear, warm weather (~50 degrees) while in Anchorage.

I spent two weeks in the ICU, which is a very hands-on, procedure-heavy rotation. The critical care docs are great teachers, they give you tons of autonomy, and you’ll take care of very sick patients flown in from remote parts of the state. In my two weeks here, I did 4 central lines, multiple bronchoscopies, an intubation, arterial line, and more.

I worked in GI clinic with Dr. Bowers for my third week, and I had a cafeteria-style ambulatory block my fourth week. Dr. Bowers is a phenomenal teacher – you’ll see clinic patients in the morning and then he’ll teach you how to do EGDs and colonoscopies in the afternoon (I did at least 5 EGDs and helped with biopsies for multiple colonoscopies). There were multiple days in GI clinic when I was able to go home at 3PM, which gave me lots of time to explore Anchorage.

Overall, you can’t really beat this rotation!

Hiking near Portage Glacier, an hour south of Anchorage
Hiking near Portage Glacier, an hour south of Anchorage
Portage Glacier
Portage Glacier
Seward, AK - a rare sunny day!
Seward, AK – a rare sunny day!
Visiting the Alaska Wildlife Conservation Center
Visiting the Alaska Wildlife Conservation Center
Snowshoeing in Hatcher's Pass, AK - north of Anchorage
Snowshoeing in Hatcher’s Pass, AK – north of Anchorage
10PM sunsets in April!
10PM sunsets in April!
Co-resident bonding in the mountains
Hiking Flattop Trail after work
Eklutna Lake
Eklutna Lake
Amiko and I getting some perspective...
Amiko and I getting some perspective…

5 star review of the ANMC rotation!

The WWAMI rotations are a big part of what make our residency program special, and I recommend prioritizing at least one of these experiences during training. The ANMC rotation is an incredible experience that I would recommend to all comers, particularly those interested in specialty medicine. The people who work at ANMC are delightful, and the attendings (particularly Dr. Lovely and Dr. Gitomer) are so fabulous that they alone make the experience worth the trip. It was a fantastic month, both for my medical training and for my life experience. Since so many of the other posts go into detail about the rotation structure, amenities, etc., I’ll spend more time her talking about my personal experiences.

In the hospital: I spent my first two weeks at ANMC in the ICU and my second two weeks in outpatient specialty medicine. The ICU is a general critical care unit, so you take care of a combination of medical and neuro patients with all sorts of different pathology. This rotation is a great opportunity to do procedures (including subclavian lines); the attendings knew that I wanted to do as many procedures as possible, so even after I had gone over to the outpatient part of my month, the attending would come get me to place non-urgent lines. You see a lot of advanced pathology, and it’s a great way to start feeling comfortable with independence in the ICU setting. The outpatient specialty rotation was also tremendous. I rotated cafeteria style with several different specialties over the two weeks, but if you have a particular area of interest in mind, you have the freedom to focus your time. Alaska is tricky for delivery of specialty care, as the population is so spread out and sparse, so patients often fly 700 miles to come to Anchorage to see their specialists. This experience enriched my medical training profoundly, and I hope as many of you as possible choose to take advantage of it.

Outside the hospital: There is a lot to do in and around Anchorage, and I really enjoyed getting out of the hospital and going hiking, halibut fishing, sea kayaking, and getting to know the city. I was there during September of 2013, which is the rainy season in Anchorage. That time of year it was generally overcast/rainy and in the mid-50s, not unlike a slightly warmer version of a Seattle winter. Anchorage is a wild place, and I saw a lot of wildlife. Kinkaid park is a great place to see moose, but I also saw one in my attending’s neighbor’s yard one night. University Lake right next to the hospital has a nice walking trail around it and is home to a lot of beavers.  Potter Marsh on the south edge of town is a must-see, and you can frequently spot swans there. Alyeska ski resort is a short drive south of town if you like beautiful views of glaciers and the off-chance of seeing a bear.

Moose are everywhere in Kinkaid Park!
Moose are everywhere in Kinkaid Park!
This is Eklutna Lake, the water reservoir north of Anchorage, in late September, 2013, the day after the first snow was dusting the mountains.
This is Eklutna Lake the day after the first snow dusted the mountains.
I took this picture while sea kayaking in Kenai Fjords national park in late September, at the very end of sea kayaking season.
I took this picture while sea kayaking in Kenai Fjords National Park at the very end of kayaking season.

In short: go to Anchorage! Please feel free to contact me if you have any questions. I love talking about all the things I got to do and see in Alaska!

Anchorage in the Summer!

Doesn’t get much better than Alaska in July/August when I was in Anchorage.  You get a sweet apartment that comes with a bed INCLUDED AND a rental car.  When I was there I split time between the hospitalists and the outpatient world.  My recommendation to people going there would be to skip the inpatient side of things (can’t speak for MICU) and do all four weeks in the ambulatory setting.  The hospitalists are all really cool but you will mostly be dealing with alcohol withdrawal, some CHF and CVAs.  The ambulatory setting on the other hand has AWESOME pathology and really super interesting medicine since people come from all over Alaska.  The general internal medicine model is super interesting there as patients are primarily followed by ARNPs, PAs, family med, etc for there general primary care needs and are referred to an outpatient internist for interesting/difficult cases.  You also have the opportunity to work with an Endocrinologist (who is awesome), nephrologist, dermatologist, GI doc, etc.  I spent a lot of time in GI and by the end he wasn’t even dressing up for the EGDs and I was doing them independently as they are mostly diagnostic scopes in patients who arguably don’t need them.

You will also get more time off and have earlier days to enjoy the endless sunshine.  Everyone gets a 5 day weekend and that’s the one I used to go to Denali where it was in the mid 70s, the mountain was out every day and I saw tons of grizzly bears, moose, and other creatures of the wild.  Do the coastal trail, climb flat top, go fishing, get a kayak and bike from one of the hospitalists and cruise around.  Let me know if you questions or need advice on what to do.

It should definitely be #1 on your schedule wish list.

ANMC MICU

I spent october of 2012 in anchorage at the ANMC MICU.  I had originally set it up as a split block: half MICU, half wards, but decided to just extend my ICU time once I was there.

It’s  a very interesting ICU to work in.  As always, spectacular nursing staff and respiratory therapists make ICU rotations some of my favorite.  They use pressure control instead of AC style ventilation as a default up there, which is a transition that was definitely useful if a bit challenging at first.

There’s an incredible variety of patients, ranging from the worst hyponatremia I’ve ever seen (Na of 98, a combination of beer potomania and schizophrenic polydipsia, wowza), to intense alcohol withdrawal, to the usual mix of sepsis and stroke management.

The opportunity to do procedures varies a bit based on the pathology mix, but even on slow days I would head across the hall to the OR and do scheduled intubations.  There was a nice mix of bronchoscopy, intubations, central lines, LP’s, and art lines otherwise.  Some people had much more procedural months than I did, I only did 3 or 4 of each of our internal medicine procedures.

The attendings come from all over, as they rely on a fair number of locums.  Dr. Madhani-Lovely is spectacular, and will force the residents to really justify decision making with an evidence base when she is on service.

The hospital itself is great, and the sheer splendor of alaska is literally breathtaking at times.   When I would leave the parking lot near sunset, I’d sometimes find myself waxing poetic and wishing for paints. The logistics of licenses and such can be a bit of a drag, so try to get started on those things way in advance.  In general, the people in the hospital are pretty motivated to help you out.

October in Anchorage

I spent this last October in Anchorage which was a great experience.  You are provided lodging in a modest apartment and a rental car.   October was a great time of the year to go, as it wasn’t too cold and there was no snow on the ground so exploring the surrounding areas was not particularly difficult.

I split my time between the hospitalist rotation and the outpatient clinic. The hospitalist I was paired with was none other than Ted Wright, former UW Boise track graduate.  I carried about 7-8 patients and admitted every weekday.  The hours were not bad. The case mix was bread and butter medicine (pneumonia, urinary tract infection, chest pain, DKA). One of the more interesting parts was discharge planning as the patients you take care of come from some very remote areas in AK.  In fact, they have a hotel in the hospital to stay at while you get outpatient follow up if needed.

The outpatient clinic experience was subspecialty medicine (renal, ID, pulm, rheum). The paired faculty are great and there was a lot of teaching.

All in all, a great month.

March in Anchorage

Still cold, but an amazing four weeks.  I highly recommend rotating at the Alaska Native Medical Center in Anchorage!

Clinical rotation:

  • You will be given a choice of (1) outpatient clinic, (2) inpatient medicine, or (3) ICU.  You can pick 2 of 3 if you want to mix/match.  I chose a mix of outpatient clinic (and requested a GI focus) and inpatient medicine.
  • For outpatient clinic, you can work with a general internist and see everything, but you can also request to work with the specialists, assuming they are available.  There are two infectious disease docs, a gastroenterologist, a rheumatologist, a neurologist, a dermatologist, nephrology PA, pulmonary, etc.  Many of the specialists see patients in the clinic, but also perform inpatient consults.  You get more weekend time off.
  • For inpatient medicine, I was assigned to an Attending (who rotates weekly).  I carried about 5 patients of a 12-15 pt service.  Rounds are pretty informal and you have independence, but still have opportunity to discuss the plan with the Attending.  I admitted from the ED.  There is good support for PT/OT, social work, etc.
  • ICU is a busy service, generally.  Less weekend time off, but a lot of procedure opportunities.

Alaska Native Medical Center:

  • Beautiful facility.  Very modern.  The patients are also amazing, mostly Native and from villages hundreds of miles away requiring travel in by a bush plane.  I learned so much about Alaska geography and native culture throughout the month.  The patients are very warm and friendly.  I really enjoyed interacting with them.

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Anchorage:

  • A big city.  Plenty of supermarkets, coffee shops (Kaladi Bros!), restaurants, gyms, museums, etc.  Even in March, snow can be challenging and I would recommend considering upgrading to a slightly nicer car with all-wheel or 4-wheel drive, especially if you plan to take some road trips.

If you have time off, consider going to:

  • Anchorage museum
  • Drive 2.5 hrs south to meet up with the Soldotna resident and then continue on south to Homer, AK
  • Hatcher’s Pass
  • Talkeetna
  • Seward (I never made it here)
  • Fairbanks is quite far and unless you have a lot of time, you would probably need to fly.  You can also take the Alaska Railroad
  • In winter, plenty of downhill skiing, cross-country, snowshoeing.  You can even organize dog-sledding/mushing, ice fishing, snowmobiling or a flight over Denali if you want.
  • If in March, try and see the start of the Iditarod (pretty amazing!) and the Northern Lights.IMG_0986

 

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Steve Vindigni

December in Alaska

Despite the negative five degree weather, snow, and a highly functional Kia Forte… this was an absolutely amazing rotation. I spent 4 weeks in the ICU working as a fairly independent entity with my own patients and responsibilities. The highlights of this were close interactions with the attending, making vent changes on your own, and the procedures. I did somewhere around 13 subclavians, 5 IJ, 1 tunneled line, 2 broncs, and helped with an EGD. The staff are great and they are interested in you and your education. I would get in around 7:30, round at 8:30 and usually leave around 7 pm unless it got busy. Overall a great rotation. Anchorage is nice, but cold. Although I did do a fair amount of running which was spectacular! I would totally recommend this to anyone interested!

Andrew Prouse