At 81, 'Doctor Dan' has hardly slowed his pace
Dan O'Connell is steady. He keeps a steady pace. His measured gait and sloping shoulders make him instantly recognizable to anyone driving by him as he walks down the road. He keeps a steady schedule, walking two miles every day, except for Fridays, when he walks five miles to Kanakanak Hospital and five miles home. In the winter, the 81-year-old foregoes ice-cleats, depending solely on his own steady balance to keep him upright.
It would be hard to overstate the importance of walking to his health, well-being and medical practice.
"If you believe in God, you'll say that God made man to stay in motion. If you believe in nature, you'll say that nature made man to stay in motion," he said. "If we don't walk, we deteriorate."
It has been 50 years since O'Connell came to Dillingham. Since that first move, he and his family have left for stints in Seattle, Kotzebue, Ketchikan, Metlakatla and Nepal. However, of all the places he and his family have lived, Dillingham has claimed them for the longest. It is where they have fished commercially and for their own food, where they built their home by hand and where they put down roots in the community.
Over his five decades of experience with medicine in Alaska, O'Connell has treated thousands of patients on both ends of life, helped develop the health aide program, watched the rise of some diseases and the fall of others and witnessed changes in the hospital and its surrounding communities. He has become a resource not only to his patients, but to newer doctors on area-specific health issues, and has a solid reputation among his patients and colleagues for his commonsense approach to good health.
Born in 1936, O'Connell grew up raising cows, pigs and chickens on a family farm that still operates 10 miles outside Madison, S.D. He graduated high school with 11 other students. When he breezed through his undergraduate courses at South Dakota State, O'Connell settled on a career in medicine.
"Just decided to throw my hat into the ring and be damned if I didn't get into medical school," he said with a wry smile.
Creighton University in Omaha owned his time during medical school, but not all his attention. The farm boy became a regular at the swing dances that nearby resorts hosted on the weekends.
"On the great plains, a lot of big name bands came through in the '40s and '50s. We danced to Louis Armstrong, so many of the swing bands in the big band era, Benny Goodman and all sorts of people like that," said O'Connell.
At one of those dances, he met Delores (Dee) Nordby. She was working as a secretary for a credit rating company at the time. He asked for her mailing address.
"About six months later, I got this letter asking me to go to another dance, and I didn't remember who he was. But finally I did remember, and so I went to another dance," Dee said, a gentle woman with a broad, infectious smile.
"And another dance, and another dance," Dan was quick to add as they both laughed.
They married at the end of O'Connell's first year of medical school. By the time he finished his residency, they had three children and no plans to move to Alaska.
"We were at a senior banquet, and I was sitting across the table from a guy I had known for a while, and he said, 'O'Connell, what are you going to do when you grow up?' I said, 'When I grow up I'm going to join the Indian Health Service and I'm going to move to Red Lake Minn.' And he said, 'Well, if you're going to go that far north, why don't you go to Alaska?'"
The question planted a seed that germinated as Dan and Dee O'Connell read magazine articles and books about rural Alaska. Shortly afterward, Dan O'Connell applied for a position in Alaska and moved to Bethel in 1963. It was three years there and one year on a Navajo reservation in Gallup, N.M., before they arrived in Dillingham.
The year was 1967. Kanakanak Hospital sat then where it does now, on the bluffs overlooking the Nushagak Bay. Today it is a network of brightly lit, modern buildings that would fit in just as easily to a small town in Colorado or Arizona as it does in bush Alaska. But in the late 1960s, the hospital operated out of a collection of quonset huts and a small building that is now an office.
"There were two physicians. There was one dentist and a handful of nurses. It was a much smaller operation, but we took care of as many people as we take care of now just because people were sicker," said O'Connell.
Now the Kanakanak Hospital operates with a team of 14 physicians and four dentists.
O'Connell entered Alaska medicine on the cusp of several key developments: the genesis of a formal health aide training program, and improving means of communication and transportation. Doctors were desperately trying to get better and faster at responding to emergency needs in the villages. O'Connell recalls the deep impact and sense of powerlessness when three women from Yukon-Kuskokwim villages died in childbirth while he was working in Bethel.
"Two of them came from the same village, and they both had lots of kids, and so it orphaned a lot of kids. And we got to thinking about, what can we do to prevent that?" said O'Connell.
Their solution was to provide medical training to people, mostly women, from the villages. That way, they could provide support when doctors were not present.
Independently, doctors in other parts of Alaska were also training assistants from villages informally to assist with medical tasks. The Alaska Community Health Aide Program was formalized and received congressional funding in 1968. Today, it is a network of about 550 community health aides and practitioners.
Annie Wilson of Igiugig, now 70 and retired, was one of the health aides who worked with O'Connell.
"He was really understanding," Wilson recalled, saying the doc in Dillingham could connect biology people did know to help explain what they didn't. "We didn't know what the spleen was, but we see it in a fish. He would say, 'Oh, it's a spleen.' He was very understanding of all the villages."
The developments in communication were more gradual. When O'Connell arrived in Bethel, fresh from medical school, his primary means of communication with the medical community in Anchorage was a World War II-era teletypewriter.
"Anchorage was very supportive, but it didn't make much difference because communication and transportation were so poor, you were on your own for emergencies," he said.
By the time he got to Dillingham, telephone lines connected much of rural Alaska to Anchorage, but communication with villages was still spotty. If someone in a village needed medical attention or advice, the message had to be relayed to Kanakanak Hospital over open AM radio, and the doctor's orders went back the same way.
"It's like that game where you sit on a chair and whisper in somebody's ear and find out what comes out at the end. Somebody would go and see the school teacher who did most of the radio work. Then they'd call the hospital and the hospital would call them back," said O'Connell.
The inherent lack of privacy involved in that radio-medicine is still a source of humor for the area's older residents, as villages and fishing boats all over the Bay might be intimately connected to some interesting situations. Sometimes messages were garbled, becoming what O'Connell calls "word salad." He remembers one call from New Stuyahok when the reception was so poor, only a few words came clearly through the static, among them "female" and "pee."
"This went on back and forth, back and forth, and I'd say 'Oh, it's a 19-year-old lady that's having trouble with her pee. Why don't you just go ahead and treat her for a urinary tract infection?"
An operator at Ekuk, however, had better reception. He could hear the person at New Stuyahok explaining the problem, and he could communicate better with Dillingham.
"He'd say, 'Doc, you got it all wrong. It's not a lady, it's a 3-year-old kid, and it's not her pee. She's got a pea stuck in her nose!'"
The doctor chuckled as he recalled that story, but he was serious when he concluded that the poor communication meant he had to rely on the skill of health aides. They were, and in most area villages still are, the first-line of medical care.
In 1970, the family moved to Kotzebue for three years. While there, they adopted a dog, which had an unexpectedly profound effect on the rest of Dan O'Connell's life.
"Of course, the kids are supposed to feed and exercise the dog, and I ended up feeding and exercising the dog. The dog was a fast runner, and I would try to keep up to it and found out that I could," he said.
They ran for miles on snow machine trails across the tundra. He started in black combat boots, not knowing that running shoes existed. When a visiting doctor suggested he change footwear, O'Connell bought a pair of green Adidas "dragon sneakers" with the iconic side stripes.
It wasn't long before running had gone from a pre-work chore to a passionate daily routine that long outlasted the dog. Dan O'Connell ran for years, even getting caught up in the "marathon craze of the '70s," as he remembers it. Back surgery eventually slowed him to a walk, which then became the all-weather, everyday routine he is famous for.
Advocating for daily fitness has been a key part of his practice. O'Connell has seen the need for regular exercise to increase, as modern conveniences have made their way to bush Alaska. He notes that in the 1960s, it was rare for a resident of Bristol Bay to be overweight and even rarer for a person to have diabetes.
"Then came outboard engines and snow machines and chainsaws and tools to cut holes in the ice, and so the activity level of the general population has decreased. That's not all bad, but there are certain aspects of it that are really unfortunate — the increase in heart disease, the increase in diabetes, obesity. All of these are related to diet and exercise." O'Connell explained.
These days, diabetes and substance abuse are his top two concerns. He is also known for a more old-fashioned, no-nonsense approach to treating patients, especially around pain.
"People expect to be pain-free, and that's not nature's way," he said. "Pain is a useful gauge for our bodies."
His reluctance to prescribe pain medications has won him both praise and occasionally contempt in the community.
"He's very caring, but you've got to be sick to get medicine. He's very conservative. There are those of us who feel the same way and think that's a wonderful thing. Then there are people who find out he's on duty and leave," said Ward Jones, longtime Dillingham resident.
"The perception of pain in the villages has really changed," said O'Connell. "Nobody back in the '60s would ask you for pain medicine. It just wasn't part of the culture. Now they're on the same wavelength as any place else. I'm not sure if the tolerance of pain is different, but the expectations are certainly different."
In recent years, in the face of a national opioid abuse epidemic that has not spared Bristol Bay, Kanakanak has put tighter controls on the prescription of pain medications. Some see this as a vindication of O'Connell's tough-it-out approach that did not soften when medications like Oxycontin became all the rage in the late '90s.
O'Connell has spent five of his eight decades on this earth practicing medicine. He says he has probably delivered 15,000 babies, and never bothered to tally how many people he has counseled, treated and healed — or comforted at the end of their lives.
These days, he is slowing down a bit, but not much. He doesn't go out on fishing boats anymore, but every Friday, Doctor Dan is still seen walking the five miles to work, no matter the weather. A few years ago, he was told he was the second-oldest actively practicing doctor in Alaska, and suspects he may now hold that unique title, though the state could not confirm.
Through dedication of energy and heart, he has played an integral role in shaping medical care in Bristol Bay, and continues to strategize with colleagues on new ways to address today's tapestry of medical concerns.
But Doctor Dan's best piece of advice hasn't and won't change, and is something he adheres to with enviable fervor: get up and get moving every day.
"A famous old monk from years ago said, 'I haven't seen a sickness I couldn't walk away from,'" he said.