Part One

with the sun riding low across the western edge of the Delta. The lighting was beautiful, but made it damn near impossible to see out my window. As we headed North, the flat marshy landscape of the Kuskokwim valley gave way to the hills (closest thing to mountains I have seen in weeks) and trees of the mid-delta range. We flew between 500 and 1000 feet, gliding along side the tops of these hills as we wove our way down small nameless valleys. With the sun setting, thousands of lakes and ponds below us appeared nearly black, without reflection or depth.
Kotlik is 143 air miles from Bethel. Our longest single flight from the center of the Y-K Delta. As we approached the village, the pilot circled around the end of the airstrip and cutting into the hazy atmosphere above the village pulled nearly 3 Gs around a turn which buzzed the clinic to let them know we had arrived. Everyone in town knew we had arrived.
On the ground, Kotlik was a much more hospitable village than many to which I had been. The mud was absent, as the entire town rested on pilings and boardwalks. A long narrow artery led through the center of the village with tendrils reaching out to each house and building. It was late, but nearly every child in the village was awake and playing on the boardwalk in some manner. We slowed on our four wheeler only to avoid flattening little pink bikes ridden by little girls. Upon arrival at the health clinic, out patient was curled up on a couch in the front room. Grumbling, he slowly moved to one of the exam tables in the back where we could better evaluate the extent of his poor judgement. A small hole, about the size of a pencil eraser about 3 finger breadths above his left nipple matched a mirrored copy just medial to his left scapula. Decreased breath sounds at the left base, and a slowly falling hematocrit reminded us that his lungs were filling with blood.. As I numbed the location for our chest tube, I pushed through the chest wall, drawing back on the syringe and revealed what we had anticipated.