Where The Road Ends
By: Emma Fenske, DO
Being from a city myself, the concept of road systems: highways, freeways, residential dimly-lit streets, and even a road that traverses the center of a mountain range are not foreign to me. When I first landed in Anchorage, Alaska, I thought that the city’s roadways resembled any other meticulously-curated grid system I had visited.
My first day on service, I met an elderly Alaska Native woman who was from a very remote village in Alaska. I remember a tenacity about her which I recognized in many other Alaska Native patients I was afforded the opportunity to meet. She presented with abdominal pain, nausea, and vomiting. A physician might recognize this pattern of symptoms and consider gastroenteritis, colitis, or any other garden-variety GI pathology, though the patient’s history of a stem-cell transplant complicated matters. As such, this added additional weight to the case and brought to the forefront a differential diagnosis of infections that immunocompetent individuals generally do not contract. After an extensive work-up, biopsies of the skin and gastrointestinal mucosa later unveiled graft-versus-host disease. In other words, her immune system was literally recognizing the transplanted cells as foreign and attacking it. But why?
Upon a deeper dive into her history, I found a new significance of the road systems that traversed the state. Living in a remote village in Alaska, my patient was unable to obtain her immunosuppressive medications to keep her body from fighting the transplanted stem cells due to not only a lack of reliable roads, but also harsh weather that hindered medications from arriving to her in the first place. I was later shocked to learn that Alaska has a mere 15,718 miles of public roads, often limiting intra-state travel in general. In order to wrap my mind around what nearly 16,000 miles means, I then uncovered that Texas has approximately 314,600 miles of public roads, though Alaska is nearly double the size of Texas. For this reason, some Alaska Natives own and travel preferentially by air not only as a means to navigate the state but because, as one patient had told me, “cars are dangerous.”
Despite the lack of roads, my patient made it from a local village to Anchorage via air travel - the only way she could.
Yet, I learned that Alaska's vast wilderness, unconnected by the roads I was used to, contained many secrets. What felt, at first, antiquated and rural helped cultivate beauty and tradition. The place the roads ended were where many aspects of Alaskan culture- Native traditions, faith, and commerce began. The lack of road systems allowed for things like subsistence fishing and hunting that provides resources and nutrition throughout the year for rural communities. Road systems, traffic, and a fluorescent two-tailed siren signifying chain coffee would not only shatter access to these resources but possibly destroy culture and tradition.
Throughout my time caring for my patient, I wondered how road systems would have affected her overall clinical picture. Would having road systems and accessibility allow for the delivery of medications, but compromise the culture, tradition, and grit that formed the foundation of who she was? I may never know the answer to that question, but I know that my experience in Alaska will change the way I think of roads in every new destination I will see.
Emma is a current PGY-3 in Internal Medicine at OHSU. She has a passion for narrative medicine, advocacy, addiction medicine, and end-of-life care. When not working, she can often be found running long distance, riding her motorcycle, or stopping mid-sentence to note a cute dog.
