When I was little, I used to want to be a cowgirl, or at least a pioneer like Laura Ingalls Wilder. Then I realized that the entire frontier had been claimed and all the open range was fenced-in and snaked with interstates, or so I thought.
Obviously, I didn’t know much about Alaska when I was a little girl. The 49th state rightfully claims the title of “The Last Frontier.” I’ve loved the atmosphere of flexibility, freedom and generosity that I’ve found in Nome and other parts of Alaska. It’s been an incredible experience as I’ve made a house call in a rural village, learned about managing diabetes by bringing the physician, nurse and dietician to the patients’ village instead of flying the patients to the physician.
I have sutured scalp wounds, delivered babies, started IV lines, gave fluids at 20,000 feet in the air, flown all over rural Alaska and seen and done anything and everything I could.
From eating dried fish to hiking over the tundra to a waterfall to trying to wrap my elbows around my arms (or was that my feet?) in one of the many fitness classes at the Nome Recreation Center.
And amidst learning so much about my community, Nome, I’ve learned about medicine. I’ve learned that the health of a patient doesn’t depend solely on me, the physician, nor them, the patient.
A patient’s health depends on the training of the village health aide to properly diagnose and triage the patient. It also depends on the skill of the pilot to land the plane in their village to transport them to Nome and on the attentiveness of the paramedics during the flight. The patient’s health depends upon the availability of the medical technologist or X-ray technician at 2 a.m. when they’ve come in to the ER with a broken arm and need their blood drawn and analyzed.
A patient’s health depends on the continuous care of the nursing staff. Also, a patient’s health depends on the community of the patient, and a patient’s health depends on the genes of their family and the behaviors they have learned.
In the midst of all this interdependence and all these factors fits the physician. Sometimes we take an active role in making the patient better, and sometimes our best role is just to stand on the sidelines and make sure all these actors play their parts correctly.
Before arriving to Nome, all of these integral parts of health care were usually anonymous to me. In my years of clinical rotations, I have rarely met the laboratory technician or X-ray technologist who have given me valuable data about my patient.
I have almost never visited the patient’s home and seen the environment in which they live. And only when working in a small ER in rural Tennessee, did I ever know the names of the paramedics who nightly transported our patients to the hospital.
Seeing the faces of all these key components critical to the care of the patient has made me realize that a patient’s health doesn’t depend just on my ability to treat their physical symptom; their health depends on a myriad of contributing factors and a community of personnel dedicated to helping them become healthier.
On many postcards sold in Nome is inscribed the phrase, “There’s no place like Nome.” For learning about all the aspects of health care inside the United States, I think I might have to say, “There’s no place like Nome.

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