Tuesday, October 30, 2012

Safely Home Ahead of Sandy

A quick post to acknowledge that I am safely home again ahead of Hurricane Sandy. There were a few times that it seemed as if I might be stuck along the way but....

Good bye Cambridge Bay
See the door to the cargo section?
Kugluktuk from the air
The plane is bigger than the terminal
Smooth travels in the north as we left Cambridge Bay on time with the airport seen here on the left and headed over for a 'service stop' to Kugluktuk (formerly Coppermine) about an hour flying time. It's more hilly over that way and a cute little airport. A bunch playing poker on the floor up front near the cargo section, the chance to buy a cute zipper pull which was a pair of beaded kamiks made by an elder who was selling them on the flight down to Yellowknife where there are actually trees. Just time to go through security (yes they actually do security in Yellowknife but I'm told because folks are flying out to places where that's expected)  throughout the north the security consists of "have a good flight" as you walk out the door to the runway, no scanner, no searches, no request for ID (likely as everyone knows who you are) just smiles. My buddy in Iqaluit told me when I questioned this on my trip there that to have a weapon on the plane was considered a positive, if the flight went down it would come in handy for security and obtaining food. Hmm. In to Edmonton where it was snowing as well and over on the shuttle to the hotel. 

A good but short visit from the western daughter and her main squeeze - a very nice lad who gamely tried everything on the menu at Yiannis - you can check out the gallery to see the place and no there was no belly dancing on Monday, just great food with huge servings meaning the kids had supper for Tuesday. 

Always good to see the girl and how well she's doing in her western life. Not that many mothers get to talk about their 2nd year apprentice electrician daughter. 

A late bedtime and a short night as I kept waking up every hour to look at the clock and was finally up before the alarm at 5 am. Down to retrieve my tote box of frozen food (we deal with the hunters coming from up north the front desk clerk told me when I checked in and asked about keeping stuff cool) from the walk in freezer. Over in the shuttle to the airport and then the games began. 

I had been unable to print my boarding pass at the hotel and when I approached the check in, the agent tells me that's because I have a reservation but no e-ticket attached to it. Her solution is that I contact the travel agent (not too friggin likely lady as Top of the World Travel in Yellowknife isn't open at 5:45 am) or buy a ticket. I make eye contact and say slowly and firmly "I - am - going - home - today so if that's what it takes, I'll buy a ticket". She walks me down the line of desks to an agent who I recognize as he solved my problems with the ticket on the way out and he eventually finds part of the ticket (says the portion from Toronto to Halifax wasn't attached) and checks me in, tags my luggage and directs me to oversize bags for my tote pan. Wish I'd gotten his name as he deserves to be recognized for his skills. With only my knapsack I'm off to the lounge where they are already boarding the flight. Onboard I settle in and wait.....and wait. First, the wings have to be deiced, then the hydraulics have to be reset, then it's been long enough to refreeze so the plane has to be deiced again and finally 35 minutes later we take off. I settle in for a broken nap - thank goodness for iPods. I awake to the flight attendant saying she has news for passengers making a Halifax connection. When she approaches my seat she says brightly "you don't have too long a wait in Pearson as the next flight will leave at 2:30 pm as you've missed your 12:30 connection". Thanks a lot! But before we're off the plane we're told again to stop at the desk as we're going to be making a connection and to pick up new boarding passes and hustle to gate 26. I do just that and have time to grab a mint tea at David's Teas as well as some loose tea and do it yourself tea bags. I eat my Canadian North yesterday chocolate chip cookie with my tea for lunch and breathe a sigh of relief as we are airborne. Apparently there was a mechanical problem with another plane and they moved passengers over to this one, meaning with that delay we got to go too. I have a very enjoyable chat with a guy heading in to Happy Valley/Goose Bay to audit The Northern Store and share my decades old Labrador info as we both trade tales of the north we've seen this far. Pretty rugged landing in the winds and drizzle but I'll take it. The son-in-law is waiting for me in the arrivals area, helps me retrieve my luggage (can't believe it made it with me as it was transferred at Pearson, then taken off and put back on the flight) and we're off. I have to borrow a dollar from him to make it across the bridge and on my way. A quick stop at Tim Hortons and a rainy, windy drive home. 

Had trouble getting to sleep, over tired, different time zone and all keyed up. Slept in as the alarm clock was set for pm and then the sorting out begins. I was pleasantly surprised to find the fridge cleaned out - what a romantic the husband is eh? A visit from (one of) the dogwalkers, a chat with the son, a load of laundry, review of mail, putting away the duffel bags, getting out the Hallowe'en decorations, walking the dog and it was time to make supper. A visit from a neighbour as her mother had passed away yesterday so we got the obituary together and emailed to the funeral home, now I'll need to start work on the eulogy. Great lady who we've known since moving to the community so easy to honour her life. 

Thunder and lightening storm as part of this major storm and it seems that in her advanced age the dog has become scared of thunder. Never used to be, you could put her out in a storm and she'd just go in her doghouse but this evening she hid behind the la-z-boy and had to be coaxed out. Bad nerves. Time to get these bones to bed as I have a full calendar tomorrow. 

Sunday, October 28, 2012

That's it.....I'm otta here

I am writing a quick update with my bags stacked around me as I wait to pack my modem and head out to the airport. The weather (here at least) looks clear (if not frigid) and I've called Canadian North to be told that 'as of now the flight is on time' so it sounds like all systems are go. Once the day arrives for departure you simply have to make up your mind, pack and go. 

I have mixed feelings about leaving Cambridge Bay as this has been a great experience but I am looking forward to seeing all my fur children and buddies at home and.....as Ahnold would say....."I'll be back" so it's not goodbye, but see you later. I am hoping to stay ahead of the predicted Frankenstorm (media term) heading towards the east coast which is a combo of hurricane Sandy and a midwest winter storm at the same time as high tides so lots of hype. The prediction is for the winds to kick up by Monday night at home and I'm 'supposed' to be in by 4 pm in Halifax so well ahead of it. We shall see. I shall be shedding my winter gear as I go along. 

I had a busy day on my last office day and the feeling that as I was starting to feel like I was making my way, it was time to wind things up. The final night on call was quite a production with many learning opportunities for me and it wrapped with me suturing. Yep, you read that correctly - I got to suture an eyebrow, 1% lidocaine, 5-0 prolene and voila. The NOC with me was patient and gave me the chance to learn (even though it was late and she could've done it in half the time) and although I'll get faster I was quite proud of myself to have learned how to tie the knots and the eyebrow sure looked a lot better when it left. 

Slept in yesterday and then got up to start throwing some things into the duffel bags. Off to have lunch with the lab tech, her husband and some other invited guests. Greek salad, arctic char, red wine and a lovely dessert in their cozy rented place. Decadent. Great conversation for the afternoon and home to get myself together. 

Spent the evening yakking it up with the roommate who although of the younger generation is wise beyond her years. She shared some northern stories as she's been several times to the next place it sounds like I'll be in January. Just waiting for a confirmation email as the phone discussion with the recruiter gave me my choice of the communities in this area. It'll be eight weeks next time so I'll feel as if I'm not so rushed. My roomie also tells me that there is one store for sure in Halifax (several it sounded like) which sell Canada Goose jackets. These are standard outdoor requirements for a Nunavut winter and cost about $800, but last a lifetime so....since Friday was the largest pay deposit I've ever received (minus the half which Stephen Harper took :( in one lump sum, I shall invest. 

So with that it's time to close down the laptop, pack the backpack and put the frozen char and musk ox burgers in the tote. Catch you on the flip side. 

Friday, October 26, 2012

Eating My Way Out of Town

Tomorrow is my last day of work in the office so I am in the 'eat your way out of here' mode and my diet has thusly not been very balanced this week. It's not as if you're going on vacation and just eating up the perishables then throwing the rest in the freezer. It's either going to be eaten, given or thrown away by the time my flight on Sunday comes. What a quick four weeks this has been - just whizzed by - can't believe I'm already talking about packing.

Amautis are a Nunavut way to travel
In Nunavut when you're talking about packing, you're not necessarily referring to a suitcase - you are likely talking about carrying a child. This might mean in a parka with an amauti, or a packing shirt or vest under a large parka with a cord tied around the waist. I've included a picture taken in Clyde River, Nunavut to show you how they're worn. The method is to lift the baby up under the arms and slide them down with their front facing your back, over your shoulders feet first, then you reach around and pull their feet so their legs wrap around above your waist and they pop their head out or nestle next to your back while you tie the belt underneath them around you or tie a knot in the bottom of the packing shirt or vest and put your parka on. And they are carried this way until they are quite large - a three year old that's half the size of his mother at times emerges from a parka.  Babies usually only wear a diaper next to Mom and a hat for popping out to the weather. They don't usually have snowsuits until they're walking. Little ones aren't carried in the hood even though it sort of looks that way, the hood is for Mom to pull up over her own and the baby's head. I've seen smaller babies carried on the front in snuglis but apparently they can be carried on the back by wrapping them snugly and facing outwards to support their neck and back next to the Moms. 
Gotta love those hats
Pang hat
Sealskin mitts with moosehide palms

And to profile another means of transportation here on the right is a family photo taken through my office window as they were setting off.  I do so wish I had one of these hats. I have a Pang (short for Pangnirtung - in the Baffin region of Nunavut) crocheted hat which is too warm to wear in the Maritimes and really only needed these past few days here so was left at home this initial trip. My Pang hat is black white and brown and looks something like the one on the left. It will accompany me on my next trip up in January for sure and will look great with my new mitts as well as being warm. Mitts you say? What mitts? Well...... these ones on the right. I bought them from a local lady, Monica who sews - they're sealskin with moosehide palms. Very warm as well as pretty and they will come in handy for 'real winter'.

Don't stick your tongue here
How cold has it been this week? Well, it's been -20 c for the past few mornings and it's only going to get colder. Can't you just see the frost coming out of that railing on the left? This is one place you wouldn't try that 'put your tongue on the metal' stunt. Folks here leave their caribou meat or char in a wooden box on the outside of their house starting in October - a big outdoor freezer. It will be like going to the tropics to head home to fall weather. And speaking of the tropics...in this small health centre there are three different staff members who are going to Haiti to do mission work within the next month. One is an ultrasound/xray tech going to set up some new xray equipment for a clinic working for an orphanage that rescues street kids freethekids.org , one is a midwife heading down to manage a  birthing centre for an organization called mamababyhaiti.org and the third is a nurse who has done several trips to Hait for Medical Teams International medicalteams.org so you can check out the groups through the hyperlinks.

I haven't learned much of the local language except koana - pronounced quana (meaning thank you) but I have a list I'm studying. What I have learned is that no is signified by wrinkling up the nose (as if something smelled really bad) which I'm relieved to find out because I thought lots of patients were making faces at me while I was questioning them. And yes is signified by raising the eyebrows (as if something had really surprised you). So you can see it's important to look at the person when you ask them a question. It finally dawned on me last week what was happening when a mother said to me pointedly - after I'd asked her preschooler a couple of times if his ear hurt (without receiving an answer or so I thought) "look - he's telling you no".

5:15 pm
5 p.m.
 It's getting dark quite early now as you can see from the photos taken after work today. The sun hangs low in the sky for quite a while before actually disappearing. I almost got taken out by a skidoo heading down the edge of the street as I snapped the first one.

Well, since I'm second on call and I've already been over once to the Health Centre for a laceration call, I should get this old body to bed. Am I tired or managing? Managing quite well. Even after a long night on call and working the next day I don't feel any worse than at the end of a 12 hour shift so it's all doable for this old nurse. I leave you with the quote of the day:

"Maybe you are here on earth to learn that life is what you make of it, and it's to be enjoyed."
— Dick Sutphen

Monday, October 22, 2012

Weekend Walks

I was trying to figure out why the last posting came up as Saturday and have decided it's because the time on my computer is still set to 'home time' and as it's three hours ahead of here, I am posting after midnight (according to my MacBook Air) or so it appears. So rest assured, I am posting this on Sunday night, not 1 a.m. Monday morning. 

I had a great night on call where I only had a couple of phone calls. This didn't mean I slept well however as I've decided that I might as well be up and working if I'm on call as I keep jumping up to look at the phone to see if it's working, check for missed messages, think I hear the phone ringing and dream about answering it. If I do get up to give phone advice or go over to the health centre on a call I have trouble getting back to sleep. I had a phone call from a young fellow at 5:45 am complaining of dental pain which sounded like wisdom teeth erupting (it does help to have had children with the same issues) and he didn't have anything to take for pain. I told him to come in at 8 am and I would see him - why I waited I don't know as I really didn't fall back to sleep. After notifying the 2nd NOC (so she'd know where I was if I didn't come back) just before 8 am I headed over to the health centre and......he was a no show. That'll teach me. The 2nd NOC told me that he'd likely been going to bed when he called me and would come in when he felt like it. I did however see a guy who called shortly after I got there who had been poked in the eye by his wife about 3:30 am when they were drinking together. He had a nasty corneal abrasion which I discovered after flushing, freezing, staining and checking the eye with a blue light. Antibiotic eye ointment, patching and instruction to return to be checked in 24 hrs - which likely won't be heeded as he wasn't particularly alert. 

Some baking and laundry then I went out for a walk in the afternoon as it was a clear day and I'm still trying to get my bearings as to the lay of the land here. I discovered a coworker's two young fellows out with their sled and stopped to take their pictures. There was a small bush and the older guy says "guess where we're going to land? right in that bush!" I just smiled as I saw that one coming. 

Made my way around the edge of town looking out towards the weather station. Lots of dogs on the roam but none to bother me. Good to get outside and clear my head a bit as I'm not used to being without my dog walk. 

Today I had a rather lazy day after my early start and so I had a nice Skype chat (yes the video call was good quality) with the oldest daughter who has rescued a very cute kitty which looks to be about 8 months old from the shelter. She is pretty, affectionate, frisky and has personality so is really welcome. Well, not as she tried to sniff hair, look in eyes, purr in faces all night - I guess no one noticed if she was nocturnal at the shelter in her cage. She won't be long adjusting to the routine of sleeping during the day when her people are at work and getting attention in the evening.  I had some text messages from the second daughter saying she'd run her personal best for the Legs for Literacy race this morning in Moncton and her youngest sister and boyfriend had shown up in T-shirts naming themselves as her team. Had a chat with the roommate (yes she's the age of my oldest child) who is wise in the ways of all things Nunavut and she educated me to lots of the community information. 

This afternoon I headed out on a walk just as it began to snow again.  As I wandered past the church there were last minute preparations going on for a baptism which I know because one of the parishioners called out to someone next door at the adjacent building to "bring warm water for the baptism". A bit further along I encountered a lady out training her husky and it made me think of walking my own dog and how pleased I am that others have taken on this role in my absence.

church parking lot

sled dog training
As I ambled down by the bay I noticed the light in behind the snow which was headed our way and the ice freezing in to the shore. The light here is different than anywhere else in the world I think. And yes now is the time to be out walking and doing photographs because in the long dark days of January that won't be happening. 

Very difficult to believe that next week this time I'll be making my way home. The time has just flown by which means that a double length for the next contract shouldn't be a problem. Already have the Alberta daughter doing some research on good places to eat in Edmonton as we'll have the evening to spend together before I head east.  Speaking of travels the shore captain is making his way home tomorrow with luggage full of his trophies so hopefully his trip is more efficient and less eventful than the way out. Apparently he and his buddy have had a good visit and no further misadventures. Off to get ready for my final week of work.

Saturday, October 20, 2012

Shorter Days

When I left work tonight at 5:30 pm tonight I thought to myself 'it seems like it's getting dark kind of early this week' and so it was. Because of being further away from the equator the days shorten up more quickly here by quite a few minutes per day in October than in Nova Scotia. When I arrived the days were the same length but the difference today was sunrise 45 minutes later here than home and sunset an hour and a half earlier.  So the lights were twinkling before I even got out of the building. 
Twilight at 5:40 pm
This has led to me putting a flashlight in my pocket as required equipment. Because of the early dusk I'm going for a walk (on days I'm not on call) at noon hour because I'm having trouble adjusting to an hour for lunch - actually I'm having trouble just realizing I can get lunch, so it's quite a switch. Returning before January 11th will mean I get to witness the 24 hours of darkness phenomenon and then the light returning day by day. And I will surely welcome wearing the parka that I am having made for me which will be available when I return. I spoke to a lady who sews today and we were discussing material so I told her I don't care what kind of material for the shell as long as it's a print because it won't show the dirt as much and it doesn't matter about the fur for the edge of the hood, cuffs and bottom of the parka (she was very surprised as apparently this is an important point for most) as I'm not picky.

Had a message from the life partner and after a bit of a rocky start what with the previously mentioned flight delays, seeing a large part of Saskatchewan as he attempted to get his hunting license and then having to be rescued when he got the rental car stuck (I assume driving it like it was the 4x4 truck he's used to). His buddy had to leave work to get him unstuck as the friend had only taken Thursday and Friday off to entertain his guest.  Apparently the past two days have gone more smoothly and he has been seeing lots of ducks and geese and actually bringing some home. He will be heading home after the weekend so hope his luck continues.

Should get myself settled down as I'm on call tonight and sometimes the early evening sleep turns into the only nap that's taken. At least with weekend call there's the catch up sleep at some point of the weekend, not like dragging your carcass in to work the next day. Have only had two phone calls - one for advice and one was a wrong number. Wrong numbers are extremely frequent up here, not sure if everyone tries to dial from memory or what - it's not as if there is more than one exchange. The phone books are numerous so that's not really an excuse and there are actually lots of folks without phones so not many numbers. In fact the phone book covers all of Nunavut and Northwest Territories.

Thinking of the teacher daughter as she's running a race this weekend. Am sure she'll do well even though she's recovering from a cold. Up here I'm thinking I need my traks for my boots as the skidoos on the road make it really slick. Enough ramblings. 

Thursday, October 18, 2012

Elephants in Nunavut?

I was notified today that I'd passed my immunization test so this afternoon did my witnessed injections. It was one of those 'just do it all at once' kind of things as I helped with twins. With the number of shots provided here in Nunavut (it's a very comprehensive list) there's no problem getting immunization practice.  

As you see the english translation is much shorter than the Inuinnaqtun version of where I spent my time last night. As second on call last night I went to bed about 11 pm, then got a call from the NOC at quarter to one to come over to the HC. We were there until 3 am and I could NOT fall back to sleep, finally drifted off after 4 am and up again at 7:30 to head over to work. It was a fairly steady start to the day but there was a very strong sewer gas odour in certain part as of the centre. By 10:30 am the decision had been made to close the building down and for staff to check back by 1 pm. This allowed me to run some errands that were unlikely to get taken care of otherwise as my working hours correlate with much of Cambridge Bay. 
Coolest little shop in Nunavut
I did a little shopping at The Arctic Closet which is a nice little gift shop sporting some work from across the territory. It bills itself as the coolest little shop in Nunavut. I stopped at Polarnet to see about my modem as the ethernet cable doesn't fit in tightly and was told to just bend the cable to fit. Um okay. Then I made my way to Kitikmeot Foods to pick up the arctic char I plan to take home. Got two big fillets and two packages of char jerky and will return next week for musk ox burgers. Apparently they can only cut red meat when the CFIA inspectors are on site. It was nippy but a great walk and a good way to clear my head and lungs from the fumes. 
Elephants in Nunavut?
Returned after lunch and did the immunizations then we were sent home again. Well, actually the HC was closed but the nurses on call kept working as where else were they going to see patients? The other problem was that all the front desk staff quickly disappeared when allowed to leave so there was no one to register patients and people kept calling as if it were a regular clinic day and there was no one to answer the phones. I offered to stay and help, or relieve the staff who had been working in the fumes even for a few hours but they declined so after asking twice, I made my way along as well. I was intrigued to see that the brisk temperatures didn't slow down the kids on the playground equipment at the school. Perhaps it's the very basic television service which is mostly reruns. I took a short walk - was stalked by one of the dogs which roam the streets - and wondered if my pepper spray would work in these temperatures. I am not reassured when my roommate (who has only been here intermittently for two years) tells me she's been bitten twice. This leads to talk of the polar bear tracks seen in town, where the grizzlies are etc. 

I am on call this weekend and at report this morning it was discussed as being the really busy weekend for ETOH related issues. It's the week after payday so you would think that the payday weekend would be the one to watch out for. Apparently it takes a while to get liquor shipped in and you have to have money to order it so…..Good to look forward to that as I'm on call tomorrow and Saturday. So after a quick supper of frozen pizza, I think it will be an early night after the rather short one last night. 

Zamboni xray techs

What goes in must come out
Firstly, to prove to all of you that the trucks do come in the north for water in, sewage out here is a photo of the truck and driver I discovered on Sunday underneath the window.  I posted this on Facebook and this morning I was gently reminded by a local lady that it was the sewage truck not the water - now that's a mistake you hope that I, not the guys at the Hamlet Office make eh? My excuse was that I was peeking out through the screen and I didn't want the driver thinking I was a weirdo.

I've been gradually finding my way around at work and just when I feel like I might be getting the hang of it....another first comes along. Well, I guess it's going to be a while before I run out of firsts what with the radical change to my practice that I've made. I am certainly feeling more comfortable with the examining, prescribing and dispensing part. One of the newer on the team staff (I assume I've taken her place as bottom of the food chain) was kind enough to point out a clinical practice guidelines document) which has been most helpful. I have been doing my own orientation as there has been no formal offering. There are some things that confound me, such as the following:

Who would think that hearing aid batteries are a prescription required item in Nunavut? Surely not this newbie CHN. I get a call from the front desk and am informed that a gentleman has been sent over from the pharmacy for a hearing aid battery. What? I think - there is no way we have a hearing aid battery at the clinic what is this about? I confer with the 1st NOC and she tells me that a prescription is required for hearing aid batteries, they are allowed four per month per ear. So I go out to investigate and there sits a man with a hearing aid visible in his ear, holding on to a battery package. I try (not completely successfully) to explain to someone who is hearing impaired with English being his second language) that we don't have a battery for him. Fortunately a coworker is with him and I redirect them to the pharmacy "we just came from there the coworker says, don't you have just one battery to give him so we can go back to work?" I assure him that Health Centres don't stock batteries. I head back to the office to have the Dr sign the prescription and she tells me that the size of the batteries must be noted on the prescription. Hmmm, must've been why he was clutching the package which I didn't have the sense to look at. Sigh. The NOC has the presence of mind to tell me to phone the Kitnuna Pharmacy for the size or his community Health Centre (she recognizes his name as being from that spot) as the communities have prescriptions filled from the Cambridge Bay pharmacy. So, I fill out the script, the Doc signs and I attempt to fax it and......the fax eats the paper and jams repeatedly. So I seek another fax - the one I find is in the registration/medical records area, is very tall and situated on a tall table so has a footstool to access it. I feel like I'm performing some kind of mountain ritual as I feed the document in. My nerves. 

Speaking of frazzled nerves, along with Meditech (the cursed electronic health records system) which has followed me here there is also the mechanical floor scrubber aka the zamboni which is used frequently and at inopportune times ex. when patients are coming down the corridors and nurses are bustling about, when you're trying to hear on the phone, listen to someone's chest - you get the picture. And also speaking of pictures the zamboni guy aka Harry (large cleaning guy) who you can hear from the other side of the building as he thumps along in his winter boots with this noisy machine is the fellow who is tasked with taking the X-rays if there is no xray tech onsite. He can only do limbs and chest X-rays - no abdominal or other ones (just as the nurses and cleaners in the communities do) but still.

On the weekend I had a one night roommate in the form of the ultrasound tech and she was great company, we enjoyed my half bottle of wine as I never before realized that I am not interested in drinking alone - how do people do that on a regular basis? She is off to house sit. On Tuesday I received a new roommate (the Homecare fill in) and she is from Nova Scotia - actually near where my mother grew up. Great to have a younger nurse with me as she looks at the situation with a completely different view. And the bonus is that she has worked as a Homecare Nurse or CHN in various spots in Nunavut so is able to counsel me on many different aspects of the casual work. The smaller Health Centres often have apartments over the HC, the on call, patient assignment, workload etc. are extremely variable. I am interviewing her as if I am a journalist as I attempt to suck all the information out of her. Her next adventure is to do 13 week assignments in Great Britain. We are pleased to find out we share an interest in tropical medicine. When discussing plans or adventures (she's worked in California, backpacked around Europe, come north) she says "why not?" And I concur - why not?

The shore captain has headed out to visit and go goose / duck hunting with his buddy in Saskatchewan and on Monday (the day he was flying out) I had a couple of missed calls on my cell as it was turned to silent. Apparently it was him, bored, waiting in the airport as he was delayed several times along the way. Those of us who know him well also know how very poorly he waits. His cryptic email said that '$30 of food coupons to spend in the airport didn't make up for the six hour wait, especially as Cabelas in Saskatoon was closed by the time he got in'. To which I have to say - if the hunting store being closed is your biggest problem, you're doing okay. Now, as for today, I'm not so sure as his hostess sent an intriguing message saying that he'd had to be rescued and that I should check with him to see what that meant. It would seem to not be (at least in my estimation) a serious thing if she is writing so casually and.... it's been a long day, I'm not sure I'm up for that so I'm off to bed as I'm on 2nd call tonight so if I should get rudely awakened from my bed I'll have at least had a nap on board. 

Saturday, October 13, 2012

Weekend wanderings

As promised in the previous post I am including the storm cancellation policy for Cambridge Bay and although the bar may seem to be raised a bit high when you see the combination of any three criteria but I am assured this happens on a regular basis:

Storm Day Information for Employees

Cambridge Bay

The Kitikmeot Senior Management Committee recognizes that there may be situations of weather of such severity as to endanger employees on the way to and from work.

One must carefully balance a number of changing factors, and be prepared for criticism no matter what decision is made.

The decision for closing rests with the Department of Community & Government Services.Consideration will be given to closing government offices in any community if a combination of any three of the following occur in a normal workday:
(1) Visibility is less than 200 meters;
(2) The constant wind speed exceeds 60 kilometers per hour;
(3) There is a wind chill index of –50 degrees Centigrade or greater;
(4) The municipality has taken its road clearing machinery off the road;
(5) Taxis or other transportation systems have given 1-hour notice of going off the road. 

Certainly didn't happen today as it was a windy and chilly but sunny day here. I spent the morning at the health centre as I had to have the NOC help me with my travel claim paperwork. With my daily meal and incidental allowance for the two days of travel I am able to enjoy a nice meal with my daughter in Edmonton each time. The travel time has been submitted as I get salary and overtime for travelling and that went in with the pay sheets this week. Today I submitted mileage which meant I had to use Mapquest to document where I was driving to and from, of course that was worth my while too. The only negative of the entire paperwork issue was that I have left the original receipt for my RN registration at home and the original is required. Too late for the shore captain to mail it to me, wouldn't make it before I left so that's $750 reimbursement which will have to wait until my next trip or for registered mail to ensure it gets here. I'll be registering again before I likely get the first one repaid. 

After all that form filling I dressed up warmly and headed out to catch some fresh air and some photos. Walked out of town to the airport. I didn't realize it was that close as it was likely just 1.5 km or so. It was a beauty of a day for pics though and it was great to get some exercise. Not many airports where you can get a photo of a stuffed musk ox or walk by a nice house in town with a caribou hide drying on the railing and a musk ox skull on the other side. Lots of dogs in town which made me miss my fur daughter at home. 
Cam Bay/ Mount Pelley

Cam Bay Airport waiting room
Musk ox and caribou

 Home for a cup of tea to warm up while doing online banking and then a call back which meant that for 1 hr 45 min. worth of 'work' I get paid a 4 hr callback at time and a half. Not a bad gig for sure.  Since I've been told by the RCMP Cst I was hanging out with that it's 'pay week' here and lots of drinking going on, it's more than likely to be a situation which repeats itself. 

A link I found on FaceBook from someone in Iqaluit describing northern life, focuses on Iqaluit but some parallels with the north in general.

Time to call the daughter who is in the same time zone as me. Later. 

Waiting for winter?

The 'regular' work week has drawn to a close and so I am now just looking at being on call for Friday and Saturday. Of course the new kid on the team gets to do the weekend call - you know how that works no matter where you are right? This week I'm feeling a little bit more sure of myself and as well it's a better situation as there has been an extra nurse added to the mix so someone is available (and not booked with their own patients) if I need a second opinion. Sure would've welcomed that feature last week as it was just - we're short staffed, here's your office and the clerk put a chart in my door and....we're off. It reminds me of the trip we took 18 years ago to South America where we travelled for about two weeks through Ecuador and Chile and then by the time we got to Argentina we were provided with a translator (who has turned out to be a long time friend). But after a couple of weeks we were already managing to avoid ordering organ or mystery meats for lunch en espanol so it felt like a bit after the fact. In the end we realized that the translator was for the mistress of one of the Argentine businessmen as she could speak NO english. At any rate I am beginning to hit my stride I think and am looking forward to another turn after the holidays so it's all good.
It snowed for a couple of days

I got out at lunch with my camera
Notice the ski too near the light 
Honda to skidoo season
 So January will be 'real winter' here. I overheard one of the patients saying to a nurse that they were waiting for winter. I thought to myself 'this much snow with these temperatures is winter where I come from'.  And to think of the rest of Canada as down south takes some getting used to because down south to us Maritimers is the Caribbean somewhere - although I guess it's all relative as it's not -11 where I come from today, it's raining. The white stuff has sure made it easier to keep up with the mud and dust though. I thought I had emailed myself a copy of the storm closure policy from the work email but I can't find it so will have to post it another time. Needless to say the parameters are a tad severe compared to 'down south'. And speaking of needing to keep warm and returning in January...I made a connection with a lady wearing a beautiful parka this week and asked where she got it - her mother (from Gjoa Haven a community in the region) had sewn it. She is coming in on Oct 24th so I have plans to connect with her to see what she can come up with. The footwear here are called kamiks (mukluks in Labrador) and I have my eye on those for another time perhaps. Especially if I want to go for a Honda (local term for 4wheeler) trip. The parkas and kamiks look something like this: 

A different colour perhaps?
Seal skin kamiks

With the weather cancelling flights the previous two days, patients were starting to back up as they waited to get out for tests or procedures and the selection in the grocery store was being impacted - still lots to eat but not as much variety. Clearly you can see that there is a large population of Newfoundlanders here as it would make you think you're in Labrador what with the Purity syrup, Pilot biscuits and all as seen below here. 
Cam Bay ethnic foods
Staff appreciation luncheon

Ah, bannock - yum! 
However, despite the challenges (and expense of northern groceries)  today at work we had a staff appreciation luncheon which included a wonderful roast ham and turkey provided by the facility manager and we all brought salads etc. It was quite a spread. I did enjoy the dried caribou but passed on the caribou fat (which I had thought was char so good thing someone educated me on that) just glad there was no fermented walrus especially after I had been studying the immunization guide to write my test and learned there are cases of botulism from it. However,  the bannock pictured above, made by one of the elders was wonderful. Haven't had bannock since 1979.

Now for all those coworkers of mine who ask about the health centre and what it looks like here is the Emergency Room areas. You'll find some distinct similarities between what I just left and the new spot. 

Trauma room 

Xray at back and obs thru sliding door

Special procedures room 
And speaking of work, apparently there is a staff member  arriving (the ultrasound tech is coming in to do all the prenatal ultrasounds for a few days) who will need to be picked up tomorrow at the airport and I'm hoping to be tagged for the job as it will give me a chance to see a bit of the town which I was whisked by on my arrival. The airport has been in the news lately with the announcement of some funding for the runway:

NEWS: Nunavut October 12, 2012 - 12:56 pm

Another aircraft damaged by CamBay’s gravel runway

Gravel damaged a First Air ATR's propeller on Oct. 10

CAMBRIDGE BAY — Airlines, which service Cambridge Bay,  and their passengers are eager to see the Cambridge Bay airport runway paved after yet another aircraft suffered damages this past week during landing.
On Oct. 10, a First Air ATR, was damaged during landing when gravel, thrown up in a mix of snow from the runway, hit a propeller.
Passengers didn’t even realize what happened, said Rudi Philips, who works with First Air in Cambridge Bay. The aircraft remains grounded in Cambridge Bay, awaiting repairs.
Cambridge Bay is one of only two gravel runway airports left in Nunavut with jet service.
A similar incident on landing damaged a 737 combi jet last May in Cambridge Bay.
Despite runway maintenance, these incidents occur every year and “the aircraft get banged up,” Philips said.

As I was getting ready to post I just looked at the description of this blog as someone wanting to run away to warmer climes and retire and thought how it might seem to others that this goal was further away. Not so, with the serious cash I am earning in the cold I will be able to play in the sun during my time off. And working half time is a lot closer to retirement than my previous full time hours. Not to mention that I am learning LOTS!

Wednesday, October 10, 2012

Molly Maid On Call

As of today, well actually yesterday now as it's 1:30 am....I have a room mate. And this (as Martha Stewart would say) is a good thing. I was expecting that I would share the apartment at some point although it's been nice to have the first week to myself to set up housekeeping. It would however, have been nice to know that my roommate was arriving today before she was actually here. I'm pretty sure I was the last to know as the SHP said to me in passing just before noon "oh, you have someone arriving today and moving in with you, her name is Kelly".  Ooops, I best get my act together and go be molly maid I thought but too late - she was already here. So, I quickly did the sink full of dishes, swept the floor and emptied the garbage as she put her things away, as I explained I'd been working most of the weekend, not exactly how I wanted to welcome a new roommate. I moved my 'stuff' around so there was a space for her things as well as you know that material expands to fill available space and it's all good. Turns out she's a very experienced northern nurse from PEI and very easy going. I am planning to pick her brain about the other 'communities' in Kitikmeot. She's worked here full time in the past and knows everyone from patients to staff so it's like old home week for her. I think my first (non family) roommate since nursing school will work out okay. 

My new roomie and I are actually not likely to get in each other's way much if the schedule since her arrival is any indication. She was foraging for her stored belongings when I arrived home late from work as I'm second on call. I made myself some supper and we chatted a bit, she indicated she'd be available to help out if anything serious like a major trauma came in during the night, and that I should leave her the portable phone if I headed over on a call. She was on the phone to someone local as I made my way back to the HC for a planned appointment at 9 pm and have never made it back. No major situations, just every time I put my boots on to go out in the snow and wind, the phone rang again. So, this will be two short sleeps and full days at work but I am counting all my O/T and smiling so it's all good. And no I am not going to brag about my earnings because remember it'll be two months of not working when I am home so I'll have to live off my savings then.

Monday I did first on call for 24 hours and still managed to get back to the apartment for supper of leftovers and in bed from 1:30 am until the morning so thought I'd fared well as the pace has been rather brisk. If you're one that's interested in stats...of the first five calls of the day, four were directly attributed to alcohol - not uncommon according to my coworkers.

The Tuesday after a long weekend is usually busy and today was no exception. I did my best to keep up and only faltered when a man appeared saying he was booked for his drivers medical. I have certainly done these but not for some time and I wasn't familiar with the form. He was moved along to another nurse who ended up doing bloodwork and more on him as he was not a good risk. It would've been the final step in my drowning process if I'd tried to deal with him. I am finally able to tell others where some things are so must be settling in a bit. This evening as I was waiting for a patient to arrive I photocopied the formulary which tells me which drugs I can prescribe as my coworkers have it memorized and rarely need to consult it. I do need to do the immunization test for Nunavut but first I need some uninterrupted time to read the material and do the quiz. The next three evenings show promise.

Almost 3 am and time to send the observed patient along home. An update soon when I'm caught up on my sleep.

Sunday, October 7, 2012

White Thanksgiving

Since today is Thanksgiving Sunday, here in Cambridge Bay it snowed meaning we had a white Thanksgiving. I have spent the day at the Health Centre working as the second on call nurse and have just finished my Thanksgiving supper of pancakes and sausages and washing a sink full of dishes from the past two days of meals and baking. When your only complaint about your living arrangements is that you don't have a dishwasher, you're pretty well set up and have a lot to be thankful for. 

I spent a few moments after work on Thursday walking down to the bay and snapped these photos of the town. My apologies to the FaceBook world as these as for the nonFace Book readers:

Downtown Cam Bay

Playing on the shore

Doug's place - most photographed house in Cam Bay

It was brisk but not overly cold and the light (although it's decreasing by about 20 minutes a day) was still hanging in there for the photos. I'd love to get outside of town a bit but my schedule hasn't allowed for it yet. And since one of the patients today told me that there were wolves on the outer streets of town as they come in when the dogs are in heat.....I may just wait until there is a vehicle available.

The view looking out my office window onto the street as I made my way through walk in patients. Friday was a busy day and I ended it with a schedvac (as opposed to a medevac) for a patient out to Yellowknife. So to explain, there is an entire division in each region called Medical Travel who arrange for patients to be flown out (and back) from Nunavut for medical appointments (scheduled as in the shortened form sched flights or the verb to be schedvacked) as opposed to medevac which is someone who can't wait for a scheduled flight as they are too unstable, might become unstable or require special equipment or personnel. The medevac company is vaguely reminiscent of Emergency Health Services/Life Flight in NS but extremely cooperative and efficient. There are flight crews for the medevac company who have a flight paramedic and a flight nurse, based here in Cam Bay that medevac out to Yellowknife and if required the patient may be continuing on to Yellowknife (usually with another company). The flight paramedics are advanced care paramedics and the flight nurse sure holds her own with them and if we get really lucky the plane is in Cam Bay and the weather cooperates - sound familiar? We do transfer of care as they stabilize the patient in the Health Center and then the First Responders are called for transport. And that's just what it is.....a big old van which the stretcher is loaded in to and everyone jumps in with their bags and they're off to the airport. Schedvac means you take your medical information and make your way to the airport with your travel voucher in hand. If a patient requires an escort as a translator because they don't speak English the arrangements are included for them. Both patient and escort have to sign a form agreeing to keep the medical appointment (patient) and not leave early (escort) as well as both of them not drink or do drugs. Accommodation is arranged for the patient if they are not staying in hospital and for the escort - if they are going as far as Edmonton there is a boarding home called Larga Home  (also in Ottawa for Baffin residents) which has translators and other patients from Nunavut there. But I digress. I got my patient sorted out with the appropriate forms (for a place without trees they sure have a lot of paper up here) his facial X-rays and copies of his records. I was pretty impressed with myself as I had a good idea that he had a facial fracture and the Doc was the one surprised so I have come a long way in a week and the time has really flown by. I sure have a long way to go however as this advanced scope of practice is like everything you always wanted to do and now you're allowed to do it. All those times as a nurse that I said "I would like to give tylenol 3s, or this person needs an IV bolus or a mask for chest congestion or an antibiotic for an ear infection" but the other side of it is that there is no one else to blame if you make the wrong call. So, diagnosing, prescribing meds - even IV meds and narcotics, dispensing entire prescriptions, ordering blood work and X-rays are the norm. There are meds which can be given as one dose and then consult the Dr or more usually one course for up to 14 days. I prescribed and gave antibiotics for an ear infection for the first time.

Saturday I slept in, then got started on the laundry, baked a batch of chocolate chip cookies and started a batch of bread when the NIC (Nurse in Charge) now known as the SHP (Supervisor Health Programs) pronounced ship dropped by for a chat to see how I was doing. Her phone rang (it was the nurse on call or NOC) and she came back momentarily to ask if I wanted to go over to the Health Centre to learn the paperwork for a medevac as someone was going out. Quickly punched the bread down and put it in the fridge, changed the slippers to sneakers and was off. First did the calls, paperwork and copying that is required to get someone out and then met the flight crew. In a rush of activity the patient was in the van and on the way to the plane. As the door closed behind them a patient came in with chest pain. Ahh, now as unfortunate as this is for the patient, this is something I know how to deal with. Not where anything is but I can sure get an IV in, get some oxygen on and fumble my way through ordering the bloodwork on Meditech - the fact there isn't an order set for cardiac workup would point to how infrequently this happens in this predominantly young population. After we get the patient stabilized and as the two on call nurses go out for a smoke (it appears I am the only nurse who is a non smoker here) I answer the phone to hear a breathless male voice announce he's at the front door with someone seizing. I run to the door as the phone rings again and it's my coworker faking a local accent and saying "the baby is coming I'm pushing now" to see if I'd answer the phone,  but as I run past the hallway she is calling from I yell "someone seizing at the front door" and the joke is on her - she quickly joins me in the foyer. The situation is under control though so we sort things out. I stay until 5pm and then make my way home to bake my rolls.

Today the phone rang at 9 am with a much less perky version of the NOC than yesterday as they'd been up until 3 am and just wanted a break until 5 pm from the 24 hr call. So I did second on call which resulted in spending the day at the Health Centre. Except for the 5 minutes when I ran (with winter jacket, hat, mitts and my NS scarf) to the Northern Store for milk at about 1 pm. And run I did as it was really snowing. The day today was manageable, I learned a lot and am starting to feel more comfortable. I do need to study the orientation manual though so I can at least wrap my head around the questions to ask.

Tomorrow I am first on call and although I won't be alone it will be good to just get through the next two days. We do first on call the first shift of call and second on call the second day so for me this will be Monday and Tuesday so by Wed I'll likely be ready for a good nights sleep. Gives me a new appreciation for Docs who don't want to get up in the night. Here however we are allowed to give telephone advice (have a form to document it on) and get paid for doing so. We are also allowed (expected) to tell people (the equivalent of a 4 or 5 on the triage scale)  to wait until the morning. Of course we see everyone under the age of two no matter what time, some people expect to be seen and insist, some come to the Health Centre without calling, others are brought in by the RCMP. There is a major problem with alcohol as in over 60% of the after hours calls to the CHC (Community Health Centre) are due to alcohol, this doesn't include other substances abused. Suicide is very high in the north with almost 50% of the reportable deaths being due to suicide, mostly young males. So, the Mental Health person is one busy individual.

Well, time to get that orientation manual out and crack the books. An update when I'm on the other side  of that call schedule. 

Thursday, October 4, 2012

Day three and I'm getting my bearings

Since this is day three of my northern experience, it is time to update all my local blog readers and post a few pictures for those who don't (or won't) have Facebook. It has been a busy few days, which is a good thing for someone trying to gain experience.

First to explain my job here north of 60 - over 69 degrees north actually - as a Community Health Nurse or CHN (pronounced chin) which has an expanded scope of practice. This means that many of the things which nurses 'down south' know and would be able to do aren't done because they are either Nurse Practitioner or physician roles. So today, after over 36 years of writing RN after my name I have diagnosed otitis media (ear infection) and prescribed and dispensed amoxicillin 500 mg TID (three times per day) x 10 days. We do a variety of tasks such as ordering lab tests or xrays without a physician's order, give telephone advice, consult with specialists, suture, glue and staple, apply back slabs (partial casts) and do debridements (removal of dead tissue) amongst other things. I haven't even had the time to read the manual yet. But one thing is clear even in these early days. It would sure be a huge switch to southern nursing after these weeks. 

First a few photos and then an overview of the past few days: 

First Air 20 seater turboprop
Nurses residence

Apartment 201

What goes in comes out

CHN 5s office at the CHC
Yes it has snowed more than once

And no I didn't buy them

So, now you know how I arrived, where I live, work and how I do my laundry and what I don't buy for supper here, oh and that it's snowed a few times already. There are no secrets with the internet to share all and so I'm well aware that it was over 20 c today 'at home' while I muttered to myself about not having my mittens on when I walked one block to the bank this evening. I feel miles away from home - oh wait I am - but yet as unusual as it is, many things are the same. I am beginning to get to know a few people - mostly employees at the Health Center and they are friendly and chatty when I meet them outside of work. Treating people as humans works the same here.

It has been a busy few days where I've met most of the RCMP members posted here as well as seeing lots of children. Of course I don't enjoy that feeling of not knowing where to find things or how the process works here as change never comes easy. I am beginning to find my way a bit though and the nursing part is the simple piece of it (except for the expanded scope of practice) as opposed to not being able to find a bandaid. I am working my way around the charts, the new form of Meditech, lab reqs, the phone advice and the local guttural accents but the names are very problematic for me and it sure makes it tough to look up a chart when you've guessed at the spelling. My mentor Bertha (from St Anthony's Newfoundland) is very patient - I think that's why she was assigned to be my mother - and is a very experienced, smart nurse. She is surprised at my energy and lack of fuss about missing lunch "I'm used to missing breaks" I tell her "I'm an ER nurse" and I do 12 hr shifts so running a bit late isn't a big deal. There is so much less crap than in the southern world - if it makes sense you do it, if not you don't. I feel as if I've been given a huge gift to broaden my practice this way.

And the financial compensation isn't too shabby either. I've discovered that I get paid mileage to and from the airport as well as being paid salary plus overtime on days I fly, hotels, taxis, meals and get met at the airport by staff. When I do on call we get a minimum four hours for first call back - even if it should be 15 minutes (this has been something I've worked 36 years as an RN and watched lab and xray claim) and then time and a half after that with double time on Sunday. There should be some serious cash waiting for me at the end of this rainbow.

Well, must run as I've had a call from a patient so am heading over to work, later gators