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Dustin Engelken was new in town when the Mount Redoubt volcano
erupted just 110 miles southwest of Anchorage. It was dead of
winter, and the third longest subzero period on record. It was as
he puts it, "not the best time to have moved there." A few days
after the volcano went off, a local TV station came to the hospital
where Dr. Engelken worked looking to interview someone about the
health effects of volcanic ash. They chose him. He was a young
physician with a new job in a strange town. He felt like a deer
caught in headlights. "What did I know about falling ash from the
sky?!" he says with a laugh.
Barely two years later, Dr. Engelken knows Alaska well enough
that he can look at a piece of Native American art and tell you
from which region of the state it came. "You can tell from the
patterns," he says. "It's been fascinating learning about the
Native American groups in different regions, what the different
skill sets are for each, how the crafts and arts are different
… their livelihoods-whether they hunt, trap or
fish-everything is dependent on the geography."
The Alaska Native Medical Center in Anchorage, where Dr.
Engelken works in critical care and pulmonology, is similarly
influenced. For example, there is a high incidence of lung cancer,
the result of rural residents delaying health care treatment
because of lack of proximity. By the time they do come in for
diagnosis and treatment, their condition is often well advanced.
The patient population is 95 percent Native American and the center
delivers a lot of telehealth services because of the sprawling
nature of Alaska, and the difficulties this presents for its most
remote inhabitants. All of these factors shape daily life at the
The 35-year-old Dr. Engelken is up for the challenge. He is
upbeat and laughs frequently, finding humor everywhere. Growing up
in the Midwest, he was drawn toward medicine and architecture, but
eventually decided on a career as a physician and later, as an
internist. "As I became more aware of my personality, and how I
thought and approached problems, I knew that internal medicine was
the right choice," he says. "It's right for me because I love
talking to people, but I also like dealing with and solving
problems, and I like things done now. I don't like waiting! As an
internist, you get to solve problems. In a way it's kind of like
While in residency at the University of Kansas, where he also
earned his MD, he fell in love with critical care. "I liked the
sets of problems," he explains. "And I enjoy palliative care. That
may seem weird, but often with ICU care, you're working closely
with the family and there's a connection there." While completing
his fellowship at the University of Vermont, his wife, who was
training to become an anesthesiologist, got the call for Air Force
duty in Alaska, and off they went.
On any given day, you can find Dr. Engelken in either the ICU or
the outpatient pulmonary clinic. He likes the intimacy of care and
thrives in critical care because of the delicacy of the situation.
"In the ICU, it's important to work with the family and the patient
on goals of care, on what they want. It's an extremely important
part of it. To do that properly for each family, you have to take a
deep breath, step back, and look at the big picture."
But not all critical care is end-of-life, and it was in one of
these instances that tested Dr. Engelken's resolve. A man in his
early 40s had been admitted with acute renal failure and severe
diarrhea, and Dr. Engelken was being strongly advised to consider
dialysis. But something about that didn't sit right with him, so
instead he ordered a quick abdominal CT scan, the results of which
reflected his inclination. He started a subcutaneous medicine and
within 12 hours the patient was on his way to recovery. A biopsy
shortly thereafter confirmed Dr. Engelken's diagnosis. "There is
always an element of uncertainty," he says, "but that's one of the
reasons I love it. In the ICU, you hover a lot, watching responses,
paying attention. It's a fluid dynamic with the patient that I
On the pulmonary side, Dr. Engelken sees patients in the
outpatient clinic. "We often get calls from rural Alaska," he says.
"People who are smokers, who are having symptoms but who are not
seeking care. Telehealth is big up here … the struggle is
how to integrate our services with patients who can't travel. The
question is how do we improve local health? One goal is to
integrate telehealth with our pulmonary services, and eventually
even into the ICU, to improve local healthcare and keep patients
closer to home and family when possible."
You can count on Dr. Engelken being invested in local health. A
few years after arriving in the Land of the Midnight Sun, a place
he and his wife never would have imagined they'd end up, the
Engelken family has found itself a home. In his free time, he lives
a full life with his wife and three children, taking advantage of
any fortuitous weather. "Alaska can be a nightmare for people who
don't like the outdoors, but we do," he says. "It's beautiful here
and has been a dream."
Check out previous
articles as physicians share what motivated them to become
physicians as well as why they chose their particular type of
October 2010 Issue of IMpact
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