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:
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| Downtown Cam Bay |
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| Playing on the shore |
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| 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.
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.
