In four, three, two…..

Since I have spent the past two hours updating the blog and have somehow through a computer glitch lost the entire post, the replacement will be briefer. I noticed the previous posting was almost three weeks ago and so yes….I am amongst the procrastinators.

theatlantic.com/business/archive/2014/02/why-writers-are-the-worst-procrastinators/283773/

It has been a busy three weeks, even though we did get a third nurse transferred in from another community as there were six nurses there and only four required. Obviously someone in staffing can't count. I had pulled an all nighter at one point and fallen asleep the next evening on the couch with the laptop. Apparently I was doing online banking as the next time I signed in I had to jump through some pretty stringent security hoops. This contract was a little calmer than last year this time as there weren't as many sick babies in the community - maybe due to the 'above and beyond' immunization program here. I'm into the home stretch of trying to get the pap smear and depo provera lists current before I leave as the creation of documents is something I can handle.

I mistakenly dipped an elders urine for pregnancy test - good thing it was negative as I wouldn't want to have the discussion about termination through the interpreter. I had a lady in last week, who actually speaks pretty good English but as I was giving her instructions she didn't want to follow, she asked for the interpreter. As the clerk was repeating what I was saying, she was answering in English faster than Louise could translate, she just didn't want to follow directions. Today there was a lady in who is now an elder with limited English and has adopted five children. She came with the baby (was a 32 wk premie) for his immunization. It's school break week so the 11 year old who was 'packing' him was quite helpful. I gave him three 'pokes' and he blew kisses to me after, so I consider him a forgiving sort. I told her that she was doing a great job and she smiled and said "you are too" made my heart sing.

I've been doing my part to support the local economy, as one of the crafts producers assured me, when I purchased a pair of snow goggles. They're carved out of caribou bone / antler and are used to prevent snow blindness, especially in the spring. The inuit have been using them for centuries. Yes, they work, but aren't great for peripheral vision. Today you're more apt to see locals wearing aviators. It is getting to be time for that spring tan.

There has been some protesting about the price of food lately:

http://grist.org/list/28-cabbage-65-chicken-and-other-insane-food-prices-in-northern-canada-2/

And really when you consider that these carrots are just a week older and wrapped in plastic for the same price…. there needs to be some backlash. I was at the COOP last week and one of the RCMP who is new to the north said "I don't really care for 1% milk" and her partner and I both said "it's got a great expiry date of four days from now and there is actually milk here". She'll learn. I bought whole milk (which I haven't been drinking since we had someone under age two in the house) and it tastes like blend if you're used to skim milk. But there were only five 1L containers as the flights have been sporadic lately so…milk is milk.

Working in the north feels as if you're employed in one large out patient paediatric unit and most of the children are great but for 'the others' here are two cute links:

http://themetapicture.com/why-my-kid-is-crying

scarymommy.com/10-things-i-said-my-children-would-never-do/

I always think back to when our children were like a daycare going on a field trip when the four of them in less than five years went out "hold your sisters hand". They were certainly normal kids but I used to feel that others sedated their children before taking them out in public. The oldest daughter had a tea visit with a new friend who has four children under the age of seven and I think was having some flashbacks to her childhood by the sounds of it.

I was out walking and heard the sound of giggles so peeked out from behind my scarf to see a group

of children making their way home from sliding. It was -50c but they were acting as if it was -5c in the Maritimes. It was 2:30 pm and just getting dark as the days are getting much longer quickly. Regardless, I am looking forward to peering out from beneath a palm frond instead of the fur on the edge of my parka.

As I think ahead to various travels, I'll share some links for your researching pleasure:

lonelyplanet.com/travel-tips-and-articles/buyer-beware-the-hidden-costs-of-budget-air-travel

For Americans who are unable to travel to Cuba as they are penalized on their return, the option of a cruise with a non US based cruise line is a possibility

cruisecritic.com/blog/index.php/2014/02/07/live-from-cuba-cruise-first-impressions/

And this researcher really makes global development come alive in this video presentation:

flixxy.com/200-countries-200-years-4-minutes.htm

I've invested in an American Express visa which gives me 30K of Aeroplan points for signing on. The key is to cancel before they start charging the annual fee - the first year is waived. Will need all those points to travel across the pond in August. Lots of exciting travel with both Mexico and then

Honduras before I come back to work. Getting excited as I've had an email exchange with the team leader for Los Encinitos and so will hopefully chat with him tomorrow night and perhaps get together in Boston next month. The big news for the summer is that….a friend and I are going to see Jimmy Buffett in concert near Boston on July 19th. That's our seats in section 13 - can't you see us just jumping around? Apparently the tailgate parties are almost as good as the concert - can't wait!!

As I think of heading home to my family and fur children, I am telling patients that I will see them in May, when it is 24 hours of sunlight, nice weather, they are out on the land fishing, hunting and camping and everyone and everything is coming to life. The following link is a travel blogger who writes about his wanderings:

nomadicmatt.com/travel-blogs/place-called-home/

And since the readjustments come when I head home and we go back to being a couple, the following is good advice:

http://thoughtcatalog.com/tim-hoch/2014/01/the-50-things-you-need-to-do-for-a-relationship-to-last/

So, I'm out of here (flight dependent) on Monday afternoon to Yellowknife and on to Edmonton after 10 pm to overnight with the baby daughter. Out by 3 pm so we can spend some time visiting and then in to Halifax by 2 am for the three hour drive home. Have a busy three days with errands, appointments and visiting, then off on a road trip to the US. Leaving Saturday to drive through Maine, and visit in New Hampshire with a summer neighbour before heading down to Boston to catch a flight to Cancun. March break family vacation and then back to Boston for the Seafood Show and home again.

Before all that happens, I have to eat up the perishable food, clean the apartment and survive two more call shifts and two work days. Busy, busy.

And of course just to give you courage to get through the day as it is sometimes tough to be a grownup:

uthas.com/2014/01/15/19-hard-things-you-need-to-do-to-be-successful/

Do I Need to Bring a Container?

As I am having as much of a 'day off' as a CHN on second call in a remote arctic community can, I shall update this blog while I wait for the FaceTime date planned with the life partner. It's only been ten days since we we've been 'working short' but it feels like longer, and it doesn't seem as if it's about to change anytime soon. I was asked if I could extend my contract here past the February 24th planned departure and I had to decline due to the Griswalds go to Mexico vacation that is upcoming. At least with the increased workload there is the recognition of additional pay as we will both be paid at the level of a two nurse health centre vs the usual three while we are short. This a new concept for me after almost 38 years of RN employment - I'll take it. The following link is not in any way related to my present employment although I sure can relate in some former positions:
http://www.ragan.com/Main/Articles/Top_10_ways_to_ensure_your_best_people_will_quit_47779.aspx#

As 2014 is to be the year of travel with multiple trips - two south and two across the pond - planned, I'll be taking my pennies saved to the money exchange. Here is link to a Globe and Mail article about nursing in Nunavut. It is for the most part true although a bit overly dramatic and some bits don't apply here. For example we do NOT suture dogs:
http://www.theglobeandmail.com/news/national/the-north/in-nunavuts-remote-corners-nurses-form-the-backbone-of-health-care/article16480170/

Regarding travel plans…..I did have confirmation from Cape Cares that I can transfer over to Los Encinitos (the original trip I planned for) in Honduras so that will mean a quick turn around the first week of May from tropical to arctic adventures. I had forwarded my trip deposit and the administrator sent a message saying the fees for my Canadian cheque were an additional $75, now I just have to figure out how to get them a cheque in US funds or do PayPal or something. Doesn't sound like there are many Canadians volunteering with them, or perhaps they understand the complexities of US/Canadian money exchange or with the changes in the exchange rate this is simply the cost. I shall consult with the shore captain on that one. He and I have been discussing a cruise to include with our Portugal jaunt in September and there are some good sales - the recent norovirus outbreak has led to good prices. And looking ahead to December and the tropical nursing course… a friend who had visited Liverpool, UK mentioned tours of the Beatles former homes and a maritime museum eerily similar to Halifax, NS except the Titanic visit is the before the sailing info. The Beatles museum is of course already on the list. And although I have no intention of going to the lengths described in this article when booking flights - I'll take my chances unless I happen to be up on call at 1 am on Wednesday night - he does makes some good suggestions:
qz.com/169299/how-to-avoid-every-common-mistake-when-booking-a-flight

But in the meantime, this contract (as they all seem to) is moving swiftly along. I am past the midpoint and so it's a slid to the finish with only three weeks left. I'm often asked by my southern nurse friends about the traumas, workload, busiest shifts and general excitement and I can honestly say that it is much more hectic to work in a small rural hospital. Yes, even working short here. There are many similarities (despite the wide cultural gap) in calls/visits to the nurse. For example….a grandmother brought her 17 yr old daughters two year old for an appointment saying that the child had been crossing her eyes at times for several days. My first old nurse / mother of four children instinct was to think that the toddler had discovered how to do this and get a reaction however the grandmother was very concerned and would not have appreciated this diagnosis. So, I patiently questioned how often? (three or four times per day) how long? (few seconds) does she just stop? (she stares really hard - grandmother pantomimes the stink eye or hyperthyroidism) and do you notice any falling, walking into things, dizziness? (no but she says she can't see and asked me for my glasses) I ask if she's had any visual problems? (she had a lazy eye when she was a baby and wore a patch) for how long? (a week) oh really? This while I looked into the very straight and perfectly aligned gaze of the two year old, checked her pupils, six directions of gaze etc. Now I consider myself pretty educated on amblyopia (lazy eye) having some experience with this in our family and am able to pick children out on the street with a bit of an eye turn and wonder why they aren't wearing a patch or glasses. Suddenly the grandmother points out "there she just did it again" and I have to calmly say "I didn't notice any difference". I suggest that if this continues it might warrant a referral to the eye team (they come in twice a year) and she says "you're going to call them and she'll go out today, should we wait in the waiting room?" Um, no, not an eye emergency. As the appointment concludes the grandmother says "do you think she has kidney failure?" which gets my attention. "Why do you ask as I don't make any connection between strabismus an renal failure?" and she says that she's seen a program on TV where some kid had to be on dialysis. Since I don't watch TV I dismissed this as a misunderstanding but my co-worker had apparently seen the program and understood the visit. I later answered the phone and a patient was explaining which staff member she'd seen "the short nurse" she says and on further questioning I realize that it was me she saw. Although I am taller than most of the community, I am shorter than my coworkers.  I have learned to interpret the statement "I try to let her take it sometimes" as the child is being given the medicine sporadically. That this is a question "where YOU'RE going?" which means where are you going? When did you take that "before" which is 'not today'. I had a lady call who has lived here all her life and gotten medications for decades from the health centre. She calls and asks for advil and tylenol - we dispense for free, why would you buy it at the Northern or COOP? When I agree I'll get the pills for her she asks if she should bring her own containers? What? We don't do refills here so I just say "no". And I have learned not to lock the apartment door - who is going to come and get me anyway? There's an outside locked door and what if I locked myself out at 2 am after making the 14 stair commute to work? The wheels turn very slowly up here and I have finally received my immunization certificate (from October 2012) as someone did an audit and discovered that I never received it. Yep, you're right…I gave up asking for it but have lugged the proof I did the work for it across the region for more than a year as I am just paranoid enough to think someone will ask for it. It came by email in the return reply. A lady who had brought a child in last fall came to tell me when she realized I was back that he had told his friends that he'd gotten his medicine from "the grandmother" which I think was meant to be a compliment in a culture which values its elders. We are starting to a bit from the sounds of the following articles but have a ways to go:
www.theguardian.com/society/2014/jan/22/nana-cafe-embraces-talents-grandmothers

http://life.nationalpost.com/2014/01/22/older-brains-slow-down-because-of-greater-experience-levels-not-necessarily-mental-decline-germany-study/

Speaking of cultural differences, one of the local staff was complaining that the school bus driver picked up the little kids who were at the stop but didn't wait for her older son and she'd had to chase the bus up the street. I assured her that the bus 'down south' didn't wait while you ambled out when you felt like it. And while I'm on the subject I continued - if you showed up at work repeatedly at noon time because you were tired from staying up all night playing poker or simply didn't come to work at all because you were 'sleeping' you would be out of a job - especially if you didn't even phone to advise this was going to happen and most certainly if you acted like this was normal when you did finally decide to attend work. "Yeah, I know" she said and shrugged. Last night we had a staff supper (no wine although I do like the wine pairing guide below) with a great menu of lobster chowder, biscuits,

chicken soup and homemade bread, salt fish and ackee (Jamaican national dish - made without the scotch bonnet peppers for Canadians) from the shore captains' salt pollock, rice, salad, scalloped potatoes, and musk ox steak. The local staff chose the date and time but only one of them attended, arriving about half an hour late and leaving early. The remainder when polled for planned attendance were going to be playing bingo, getting ready to go out on the land, shopping or didn't know what to bring, one still maintained she was coming (didn't) and the bingo player asked if I'd save some lobster chowder for her even though she wasn't coming "nope!". The four of us 'outsiders' who whipped up the feast enjoyed ourselves but certainly could've chosen a time more convenient for ourselves. Such is the life of an ex-pat living in another culture. And for those who ask about the cost of northern food and how do locals afford it, well….they don't very well:
http://www.theglobeandmail.com/news/national/the-north/why-is-food-so-expensive-in-nunavut-shop-for-yourself-and-find-out/article15915054/

I had made a chocolate birthday cake for the mental health worker on Monday and told her we'd take a little break in the afternoon and share it. I went to her office and we retired to the staff room where we found the cake half eaten so asked who'd devoured the cake as it wasn't their birthday and I was told "Rita and David said it was good". Sigh. The positives are of having my own private hunters market of fresh musk ox tenderloin delivered to the door, fat arctic char or the offer of redfish (which I confirmed had something to do with it being a sexually active char who had beige not pink flesh and none of the local staff cared for it as much as the real char) which I politely declined. Here's a link to a Globe and Mail article with some good pics and yes it is a long (but excellent) read :

http://m.theglobeandmail.com/news/national/the-north/the-magnetic-north/article16364070/?service=mobile

In a repeat of the article outing today the home care nurse arranged to go out on the land with a local hunter and was hopeful of seeing a muskox (they didn't - just signs) but they stopped and fished in the lake through the ice and he brought back a nice lake trout he'd caught. He was pretty pumped! One of the benefits of working Monday to Friday with weekends off, to plan such excursions. He had a great day for it a it's been warmer at about -30c and was sunny from 9 am to 2 pm. Since the sun has returned the days are getting longer very quickly as they start heading towards the 24 hours of sunlight.

I had a nice message from the nurse daughter stating she had been charge nurse on the busy 36 bed

medical unit where she is a newly graduated nurse of only six months. Pretty impressive progress as there are some who are still struggling a few years in. She commented that she had been in charge of the Gong Show and all patients and co-workers were alive when she left. All that you can ask for. And for nurses everywhere I offer the guide on the left to interpreting physician's handwriting, I can use it this week as the Dr is coming in to do his monthly clinic. It took me a minute but it was a laugh out loud moment, maybe it's just nurse humour. Anyway, its no surprise that she is following along in her sisters footsteps of being a responsible employee and grownup. According to the newspaper article I read this morning she (and her siblings) are apparently in a group known as cord-nevers which is described as those under the age of 30 who don't subscribe to cable but use the internet to watch their programs. More easily done where one doesn't pay for bandwidth by the GB.

Off to study a bit of tropical medicine. Joined MEC (Mountain Equipment Coop) and ordered a water filter and purification chemicals. Am sure the life partner will be pleased to have to make a trip to town when the card is delivered to pick that up.