Sunday, January 19, 2014

Stress Test

As I sit snuggled under the LL Bean down filled throw to counteract the -54c temperature which is trying its best to get in through the 1980 windows of the apartment, with the on call phone at my elbow….I shall update the goings on of my January / February location life. Hard to believe that I'm looking at my through the third week of this two month contract. Fairly steady day of call - about seven hours of routine visits and calls. I spent a couple of extra hours clearing out the 150 emails which accumulated in my work email in my absence. The only call since 7 pm has involved a transaction for a lovely filleted arctic char. 

The big news of the weather locally isn't the frigid temperature as they are expected although, when a local said "it's cold, really cold" today, I was pleased to be on call and not expected to venture outside. Rather, the weather site is predicting a sunny week as the sun rises above the horizon here again. Albeit for a brief appearance, but every day the light will remain for half an hour longer. This I have on authority of one of the CARS operators, who I have until now understood to be a version of local air traffic controllers. I was alarmed to discover their priority is recording the weather. I have apparently had a false sense of security that they were assisting the planes to land on these high arctic air strips. Obviously current weather conditions are extremely important but… is simply those pilots peering through the windshields and at the instruments of those turbo prop or jet planes in rapidly environmentally changing remote locations who ensure we take off and land safely. Nice to know. 

This past week I survived what has become my traditional second week of contract viral illness. I am guessing the usual head cold is a combo of airplane travel - recirculated germs, large numbers of people, not enough sleep and the change from the moist maritime air to the arctic desert devoid of free humidity. Add to this the examining of large numbers of ill children bearing a cold virus I haven't been exposed to and it's a perfect storm. The fact of simply have to work again after being a free agent for two months is enough to cause the body to rebel. 

This week through a period of trial and error (and need to do it myself as my junior sidekick who enjoyed doing them and was good at them has abandoned me for another area this contract) I finally wrapped my head around doing manual white blood counts. It's not something we do regularly so you have to follow the 'recipe' but I have finally mastered the concept and when I practiced on myself with a fingerprick (glad I don't have to do that regularly) I got a 9.3 - which is likely pretty accurate for an old nurse with a cold. 

Oh, and I also had a bit of a stress test last week. I had examined a two year old and his mother who then followed me out to sit in the waiting room while I dispensed the medicine I was treating them with. As I walked back from the pharmacy I handed the mother (who was chatting with a friend) the bag of medication, repeated my instructions for yet another time and returned to my desk. I sat down and started the process of lengthy documentation - for any nurses reading this we use the SOAP charting method and record a complete head to toe exam including vital signs - so it takes a few minutes of steady concentration. I was a few words into my note when the little imp (who had apparently hidden himself next to the bookcase) jumped out at me and yelled "RAHR". Those who know how easily I'm startled will not be surprised to learn that I screamed loudly, jumped up out of my chair, then fell back into it with a loud thump hyperventilating while grabbing my chest as I tried to catch my breath. The little fellow was very pleased with himself and doubled over at the waist giggling. By then I had a good chuckle myself. I took him out to his mother and told her that he was lucky a woman of my age with four children hadn't wet herself in the office chair. "Oh he's learning to scare people like that" she said smiling. I am sure he'll repeat this as it worked so well and he was very entertained. And, true to form in healthcare, the screaming did not lead anyone to investigate if there was a problem. Takes more than that to get attention. 

Speaking of getting attention….I can tell you that if you are a CHN on first call and you hear loud yelling outside your window as you're settling for the night - you pay attention. The health centre with apartments is next door to the arena which is a busy spot for many months of the year. As I looked out the window I saw the zamboni which had been driven out through the back door surrounded by a group of at least eight people, lots of yelling, running around, jumping on and off the machine and arms waving. First thought 'oh no, someone has been run over by the machine or a body part is stuck in it' but a few seconds of voyeurism caused me to realize that the zamboni had been too vigorously driven out to dump the ice shavings was embedded in a snow pile and quickly frozen there. It was the equivalent of a crowd of teenagers lifting up a volkswagen. A large cheer arose when the machine was freed and steered back through the doors. Whew. 

If I was tempted to use the descriptor 'very' there are always lots of occasions up here. However the chart on the right outlines lots of options for the writers amongst us. Which is the reverse of the Mark Twain quote "never use a five dollar word when a fifty cent one will do". Less syllables are better when dealing with a population using English as their second language and basic concepts are easier for the clerk interpreters too. As I listened to the clerk relaying my instructions to a patient I asked "what does the word that sounds like pee mean?" and she thought for a moment then said "it means umm, like I'm thinking of what to say next" and we both smiled. We had an interesting appointment this week where an elder (who is usually quite chatty and smiley) was extremely angry about a situation and the eyes were just snapping. You don't have to understand the words to grasp the emotion. We went through the "tell me what the problem is to I understand your frustration, this is how it has to be just for now, I would be frustrated too if it was me, is there anything I can do for you?" scenario. All this through an interpreter, who was clearly NOT interpreting the entire blast and was quite flustered at how I was being talked to. As we concluded I instructed her to tell the patient that I did not take this personally, that I understood it wasn't about me and that this situation would be dealt with. The final translated statement from the patient was "you took this very well and I appreciate it" and I instructed the clerk to say "I'm a nurse, this isn't the first time I've been in the line of fire, I've had lots of practice" and I added "I know you were just worked up and I'm not writing down your blood pressure because if I do you'll find yourself in here for weekly B/P checks"! That was something we could both agree on.  

I was pleased to receive a conditional acceptance to my query about the diploma in tropical nursing program I'd applied to for December 1 - 19, 2014 in Liverpool, England. Will have to save my pennies from these contracts for airfare. A little bump in the road with the plans to do a mission in Honduras as the dates for the Oparato trip had to be moved to later in May (I'll be back to work) but I am hoping to transfer over to the Los Encinitos trip which is April 26 - May 3rd. This is the original date I looked at and scheduled my northern contract return for but….it'll be a bit tighter than Oparato. I leave a lot of things here now and the commute is getting more routine so… I really must study Spanish more diligently. 

Hopefully I will get some shut eye tonight although on the weekend there isn't a full workday awaiting. And should the sun return about noon I may even manage to sneak out for a photo as I'll only be second call. No good to make plans in a small health centre as there are only three nurses to manage whatever comes through the door and even on an evening 'off' there can be one of those "all hands on deck" calls - have been involved in a few of those. I had an online chat with a former high school classmate who has gone on to be a paramedic and is now heading in to northern Alberta to do camp work. I asked about the number of employees and he responded that it was about the same size as this community. When I enquired about how many medics he advised there were two ACPs (advance care) and four EMTs (emergency medicine techs) so….exactly double the number of nurses we have here to handle a different culture north of the arctic circle with limited resources, prenatals, babies and children, chronic diseases, trauma, communicable diseases, immunizations, lab work, x-rays, casts, dental issues, suturing etc all without ground transport, first responders or medics and medevacs weather and logistically dependent. So, I assured him that he was extremely well staffed for a working population of essentially well employees. 

FaceTime date with the life partner is the highlight of the week tomorrow. One of the staff who had gone out on vacation for six weeks had lost some plants in her absence due to house sitter neglect and I told her that I make the shore captain show me the animals and plants on video chat. Not that I don't trust him but ….the cleaning lady is still making a good post op recovery and thus isn't doing the weekly checks on him. Hasta. 

Friday, January 10, 2014

Traffic jams and lobster sandwiches

An update just because I can and….because it's too early to call it a night when I'm first on call. Never good to settle down too soon, then get called out all disorientated and try to get back to sleep.  There has to be a balance however as I had one of those 'went to bed too late and then got called at 5:30 am nights' my first night on call, resulting in only four hours of sleep.  An hour is not quite enough time to get back to dreamland before the alarm rings and the total of four hours is not enough for even this night owl. 

Part of the reason for staying up too late on a weeknight was the excitement of hearing from the team leader at Cape Cares and finding out hat I was in for the April 12 - 19th volunteer mission in Honduras with the added carrot of a second (optional) week at an orphanage with some vacationing tossed in. Yes, please sign me up. So, you can logically see there was good reason to be up until 1 am downloading Spanish medical dictionaries and texts to my Kindle. Truthfully - I was just too pumped to get to sleep! Only three more months, but who's counting?

It is of course, the usual for this time of year in Nunavut weather here, which means -40c and 24 hours of darkness. So you can imagine that there is a lot of smiling and shaking of heads about 'down south' where folks are caught in a 'polar freeze' this past few weeks. One of the locals shared that he'd seen a story where the Chicago Zoo was taking the polar bear inside as it was too cold - this was funny to him on a number of levels. I cautioned him not to be so quick stating "I flew through Chicago in December and it felt colder than here" and he left chuckling. The weather in western Canada has been colder many days than north of the arctic circle, there was the nasty blizzard in the Maritimes which I narrowly missed and then this week a snafu in Toronto which is still working its way out of the system. A nurse from NS flying into a neighbouring community here left Halifax early Monday morning and only made it out of Pearson today, is overnighting in Edmonton as I type and will make her way north of 60 tomorrow. Just a five day commute! And usually it's the northern travel which gets a bum rap. 

The large weather system which wrecked havoc in central Canada moved up through Nunavik (northern Quebec) and then Baffin / Kivalliq causing a major blizzard which had winds of over 120 km/hr with low temperatures, blowing snow and lots of folks without power - not a good thing at those temps! This of course made the news and I had some thoughtful inquiries about my safety from southern friends. I reassured that Nunavut is huge - 2 million sq. km and three time zones - so here on the NW Passage (see red arrow) we were well and truly away from all the action. I shared this route map from one of the airlines to illustrate my point. And you really should enjoy Rick Mercer's weather rant on Youtube (just Google) it - it will cause a smile. 

I am not suggesting that I am finding the temperatures balmy here as I go through my second annual readjustment to Nunavut in January. It is eyeball freezing cold as that is the only part of my anatomy exposed to the environment! As i shuffled (only way to describe walking in that many layers) up the hill to the health centre/apt back from the COOP I muttered to myself about my choice of work areas etc etc. But I had been on a mission to buy bread (and yes I asked someone if there was bread at the COOP before I ventured out - the second option would have been to call the store) as I had promised lobster sandwiches to the local staff. None of them had ever eaten lobster (no surprise) but after today they are all eager lobster sandwich fans. 

Today as I made the sandwiches and grabbed a quick lunch, I looked out the window to see
Traffic jam
the school bus at the intersection near the health centre as it prepared to make its way to Netsilik School for the afternoon. There are very few vehicles here so snapping a photo with the bus and a truck together - constituting rush hour - is quite a coup. And as someone who used to work in the community commented " wow a traffic jam and with Disneyland in the background too" as that is what the area of coloured houses are known. And yes, it is as cold as it looks. 

My first week back after resting my brain for two months has been a busy one. Perhaps folks are getting back into the routine with the kids in school again after 'fixing their sleep' which some loyal blog readers might remember as discontinuing staying up all night and sleeping all day as they did over the Christmas break. There was the combined frantic schedule of having both the physician and dental team in a small health centre at the same time. The dental team arrived on Monday unbeknownst to the Nurse in Charge after there had been a lot of effort employed in readying the space for the Dr. clinic. Not good. There are just so many available spaces to be used and it was a game of musical offices for the nurses until late this afternoon. And of course extra blood draws, procedures, requests for information by the Dr. because as any nurse knows…. that is what physicians do best. Now we go back to just doing our thing and using the phone. The H1N1 influenza outbreak is moving across Alberta and it will be only a matter of time before we find ourselves dealing with it. Some of those who chose not to, or couldn't be enticed to have influenza immunization have now changed their minds and are asking for it. Too late as all the vaccine has been given. 

Now that I've finished my pistachio dreams tea perhaps it's safe to take the phone to bed and read a few screens of The 100 Year Old Man Who Climbed Out the Window - it is a wonderful read!

Sunday, January 5, 2014

And It's back to work I go

Settled in safe and sound in my northern home and time to update. I have been doing my Spanish studies and playing with the magnetic words en Espanol on my fridge and the phrase of the day is:
soy la reina de mi casa. 

The commute is getting to be regular if not routine and this time it went very smoothly. I started out at midnight, drove to my classmate's place in Middle Sackville (where I left my car for them to store in the garage) met the cab I'd arranged for and was deposited at the airport, check-in was painless with one bag weighing 23 kg and the other 22.8 kg (max 23 kg) and then on with only the knapsack. A Tim Hortons breakfast and short wait in the departure lounge. Off to Toronto while I napped and due to some delays just walked off one plane and boarded the next. Spent the Toronto to Edmonton flight between two tradesmen going back to camps in Alberta, watched The Big Wedding (very simple story line but Robert DeNiro, Robin WIlliams, Diane Keaton and Susan Saradon so very watchable), read my book The Rosie Project (highly recommend it) and napped some more. Shuttle to the hotel, dropped the bags, arranged for a cab (lengthy wait which is apparently common in the winter in Edmonton) and then to WalMart for perishables and the liquor mart for butterscotch ripple schnapps and when I questioned the clerk as to what whipped cream vodka tasted like she suggested that putting it in orange juice made it taste like a creamsicle (sold) and that cake was like white cake  (duh) worth trying the sample sizes at least. Back to the hotel to meet up with the holder of my action packer and catch up on the news before the electrician daughter arrived after work. Roads were messy so we had a late supper in the restaurant (one of the benefits of staying in a place with a dining room) and sleepover. 

Good to spend some time together although I felt guilty in the morning when there were traffic advisories for her return trip. Her solution to the problem was to head across country and visit her sister in Saskatchewan for the weekend as they had planned to get together anyway. Had the hotel store both my action packers  in the walk in cooler so in the morning they just wheel them out on a cart - no messing with elevators/carts etc for this chickie - and over to the airport, with the daughter dropping me off, so no shuttle. Check in / security, stop at the ATM for cash, quick shop at the bookstore and wait for the flight. Bit of a delay but we're finally walking out across the snow covered tarmac and up the steps to the plane. As I move to take my window seat I notice that the Regional Nurse Manager is my seat mate. What a surprise! Quite an interesting journey from Edmonton to Yellowknife. In to the terminal, time to put on the snow pants and transfer to the Dash 8 and we're off. Not able to land in Cambridge Bay due to weather so head over to Taloyoak and arrive early. Have to have Chuck from Canadian North call the health centre and announce my arrival and I am thrilled to find that all three pieces of my baggage have arrived. The caretaker deposits me and my stuff at the health centre, I retrieve a key to the apartment (oh good I have the one with the decent oven) and begin the shuttling and storing of provisions. Well, actually I store the perishables, find my internet modem and sit surrounded by containers while I chat online. A surprise phone call from my buddy at home who is describing the huge blizzard that I so narrowly missed which is now making air travel impossible. Make the bed and crawl into it, the non perishables can wait. 

After sleeping 12 hours I awake to complete blackness at 10:30 am and have to reorientate myself "oh yeah, that's right you're up north again" I say to myself. It takes another couple of hours to organize and store the groceries and clothes and I'm good to go for eight weeks. My personal humidifier has died but this is a first world problem. Some online chats and then suiting up for the frigid temps and a quick trip to the COOP for milk, eggs etc. I introduce myself to my co-worker in the next apartment who is pleased with my arrival as they have been working short for almost a month here. At the grocery store I see lots of familiar faces and am wished "happy new year" multiple times. A cold trudge up the hill. Some Spanish studies, finished my book and fall into bed. Glad that no one knew I was coming and so I didn't get put on the call schedule for the weekend - good chance to rest up. 

Today was a quiet Sunday where I decided to head out for some photos when I noticed a slight lightening of the sky at almost 11 am. Put on my heavy pants, snow pants, heatmax socks,kamiks, parka, pang hat, scarf, sealskin mitts and realized about 30 minutes into my trek that I should've worn long johns as well since it was -46c with the wind chill - forgot just how cold that is (still warmer than Saskatoon mind you) and that my face mask doesn't ice up  
Front of the new health centre
Noon time 
as much as a scarf. The camera protested and so I slipped it into my mitten to make it cooperate. It was completely dark by 1 pm so glad I got out when I did. The construction on the health centre next day is on hold until March but they did manage to get the exterior enclosed this fall. Not much moving today except the water trucks, some road hockey and  a few hardy souls on skidoos. In to warm up and a chat with a former boss from the spring who has moved on to an 8 week job share as a nurse in charge in NWT and is enjoying herself thoroughly. The nurse in charge called to see how I was doing as I had been keeping such a low profile "hibernating" I told her. Readying for the physician's clinic this week she was (as usual) busy. I posted some photos to FaceBook and had a former co-worker tell me that she felt sorry for me and was thinking I was cold and homesick. I instructed her not to feel sorry but to feel jealous for me as this is a wonderful community, great people, good job and I am loving it! Had a FaceTime chat with the shore captain as I was wondering if there was any damage from the blizzard, storm surge, ice etc. but apparently they were fine. The dog was sleeping on the sofa which I described as the 'downward dog position' but she ignored us due to her profound deafness. And I must describe the shore captain as profoundly confused because he mentioned that today was January 7th (it's the 5th) and was insistent about this when I held my ground. I firmly advised he consult the calendar, he did and then admitted that all the paperwork he'd submitted to ship lobsters across the border had gone with the Jan 7th date, "That'll be interesting when the shipment reaches the border, when will that be?" I said. "In about an hour" he replied. So, I expect he received a call about his confusion. Made an oatmeal cranberry loaf this pm as I was putting pizzas in the oven anyway so getting into the swing of things. 

With the busy Monday tomorrow of blood draws, Dr. clinic and the usual "been sick all weekend" walk ins perhaps no one will notice that I'm frantically trying to replace all that information I erased from my memory in my eight weeks away. Here's hoping.