Practicing Where Psychiatry Is On Top of the World
This is the Inupiaq (Eskimo) town of Barrow, Alaska, on the Arctic Ocean—the northernmost town in Alaska, the northernmost town in North America, and arguably the northernmost town in the world. It is also the place where a wiry, boyish, 47-year-old psychiatrist named Greg McCarthy, M.D., works one week a month.
It is Monday, August 11, and McCarthy is scheduled to put in five working days in Barrow.
Early on Monday morning, he drives from his home in Anchorage to the Anchorage airport, boards a Boeing 737 bound for Fairbanks, then Barrow. During the three-hour flight to Barrow, he catches up on journals and Psychiatric News. Once he arrives in the terminal, he walks to the town’s mental health clinic a half-hour away. Both the airline terminal and the clinic are located on Ahkovak Street, the main street in Barrow.
Once at the clinic, McCarthy is helped by Rachael Stafanson-Layne, R.N., a psychiatric nurse who has been working at the clinic for about three years; social worker Jerry Nordstrom (whose wife, Patty, works in the clinic in the substance-abuse care); social worker Chris Nordstrom (Jerry and Patty’s son); and some other staff members.
After he is through seeing patients, he talks with other staff members for a while, goes to dinner in one of Barrow’s few restaurants, takes a walk, then goes to sleep on the couch in the “gathering place.” The gathering place is a building next door to the mental health clinic where persons with serious, chronic mental illnesses can “hang out” during the day—that is, socialize, prepare their own meals, and eat together. Stafanson-Layne calls the gathering place one of the “jewels” of Barrow.
Over the next three days, McCarthy follows pretty much the same schedule as on Monday except that he doesn’t have to fly anywhere. Friday, however, is exactly the reverse of Monday. He works at the clinic until evening, then packs his things in a knapsack, goes to the airline terminal, and hops a jet heading south to Anchorage.
Other Destinations
Barrow is not the only rural area in Alaska where McCarthy practices psychiatry. He also consults from one day every quarter to one week a month in places like Dutch Harbor in the Aleutian Islands; King Cove in the Shumagin Islands; Kodiak on Kodiak Island; Seward, which is south of Anchorage on the edge of the Gulf of Alaska; and the Kuskokwim Mountains.
“My experiences in these places are similar to those in Barrow,” he says.
Although other Alaskan psychiatrists live and work in rural areas, and several others who live in Anchorage and consult in rural areas, McCarthy believes he is the only psychiatrist who lives in Anchorage yet does all his work in rural areas.
Wildlife Poses Unexpected Challenges
Not surprisingly, McCarthy faces some daunting challenges in his work. First of all, there are the physical dangers. Although he came across rattlesnakes while growing up in Oklahoma and has encountered black bears and grizzlies while hiking in Alaska, “my biggest fear is moose,” he admits. “In other words, when I drive from Anchorage to my work in Seward, it is often in the dark, and if I hit a moose, both it and I would be goners!”
Second, dealing with the weather is a constant battle. For example, he says, “There are terrible winds in the Aleutian Islands, and it’s not uncommon for me to be stuck there for several days.”
In addition, when McCarthy works in these rural areas, he has to interact with a lot of different systems. “Each mental health center is organized a little differently,” he explains, “and some are more functional than others. What’s more, staff turnover is a terrible problem. One center has had 27 different directors in 15 years.”
While many of the mental health problems with which McCarthy helps rural Alaskans cope are similar to those that people in other states experience, there is a particularly high prevalence of depression, alcoholism, suicide, homicide, and sexual abuse. “I’ve visited some of the graveyards in the rural areas and been struck by how short the lives of many rural residents are,” he exclaims.
Some of the mental health issues that McCarthy tries to help patients handle are unique. He has seen people who have been attacked by polar bears, grizzly bears, or black bears or witnessed such attacks; people who have been lost in blizzards on the tundra; and people who are grieving for loved ones killed in all-too-common small-plane or snowmobile wrecks or in fishing-boat accidents.
Psychiatry by Pickup Truck
All of these demands, however, are tempered by some amusing experiences. For instance, McCarthy has ridden small planes, ferries, crab boats, and snowmobiles to reach patients. Once he was the only passenger in a small plane filled to the ceiling with cases of powdered milk—“truly the milk run,” he recalls with a grin. He has diagnosed and treated patients in the back of pickup trucks, fishing boats, log cabins, even meat lockers.
Along with the amusing experiences, of course, come some other rewards. “I get to do a lot of traveling; I get a lot of airplane peanuts!” McCarthy chuckles. “I also see lots of different cultures and meet lots of different people.”
Turning serious, he adds, “I also believe that I am providing some continuity to staff and patients in the areas where I work, as well as some outside perspective—for example, the tundra is both greener and browner on the other side of the fence. And, most crucially, I like to think that I’m making a difference in people’s lives. Many times I help them get better or at least keep them from getting any worse.”
“Yes, I think I’ve found my niche,” he says with a smile. “Nobody else wants to do this kind of work. I like it, and my wife doesn’t object too much.” ▪
