Wednesday, October 29, 2014

Welcome Nunavut Baby

So at about the two week mark since the last post, I am ready to update you. I was ready to update you many times before the two week mark but…..northern life got in the way. The eight week contracts take on a rhythm of their own where as you ready to travel in, you don't really want to leave - kind of like looking at the last day off before heading back to the next set of shifts - but once you start packing and actually get going, it's not all that bad. Once you're 'in community' you just settle in and make up your mind to make the best of it and then….. I've found that the third week in of the contract is the longest, where it seems like I've been here a long time and still have a long ways to go - this feeling only lasts for a couple of days and is akin to losing sight of one shore while not being able to view the one I'm headed to. I am past the mid-point marker with only three weeks remaining and as the slide to the finish edges closer, the time seems to speed up. Such is the life of a transient person. 

We had (another) blizzard last week and as we were in day two of what looked like four snow days….we delivered a baby at the health centre. A prenatal (who was booked to travel out the next week) having her fifth baby and was about 35 weeks gestation, slept through the labour and presented herself with regular contraptions about 5 minutes apart and almost fully dilated. I was giving a lady the antibiotics for her chest infection I'd diagnosed, when my roommate appeared at the pharmacy door and said "you're the maternity nurse, we're having a baby, come on" and….away we went to the OBS room. I decided not to share that it had
been at least 20 years since I'd been an OBS nurse. The physician (although only 28 yrs old is one of those wise souls) had delivered about 100 babies and the room was all set up. Now, a blizzard, in a fly in northern community is not where you'd choose to have a premature baby but….this was one of the smoothest and easiest deliveries I have seen and that lusty cry was the most welcome sound! Jakson who must've wanted to be a Nunavut not a NWT baby arrived at 11 am, was a good size, very vigorous and both he and mother were stable. The nicest part was that although it was their fifth child, the father had never been present for a birth (as prenatals wait at least three weeks and deliver - usually alone - in Yellowknife) and Dad was very supportive and emotional. The siblings came with their grandmother an hour or so later and weren't told they had a baby brother - the looks on their little faces when they realized he had arrived was priceless. We called for a medevac that afternoon after he didn't feed well and his sugar dropped and somehow….the pilot landed about 8 pm that evening in just about zero visibility. I couldn't find the door of the plane to drive up to on the runway, the wind took the door of the SUV from my hands and we plowed our way through huge drifts on the way to the health centre with the medevac crew looking out each window to see the edge of the road. As I returned them to the airport and the flight nurse took ahold of that mother to help her walk across the polished ice surface with a premie in a Snuggli under her parka, I found myself getting emotional. I struggled over
loading equipment 
to the door of the King Air where the pilots were arranging equipment in the cramped cabin with the flight paramedic as the wind whipped snowflakes into my face, stinging my cheeks and making me squint and said "I want you to know how much we all appreciate the fact that you made this flight tonight"walking quickly away as my voice faltered. As I beat my way back through the walls of drifts, fishtailing on the slick icy roads, peering out through the frosty windshield hoping I was still on the road, I though of the wild ride for crew, mother and child on their way to Yellowknife. 

5 pm sunset towards the airport
It's well and truly winter now and the snow machines are out in full force. Still a few Hondas around as they'll still start, but the roar of skidoos is the predominant sound. Very disconcerting when you're first call to see and hear them whipping by. As I was walking home from the store the other day, the smell of snow machine exhaust from two that passed me caused me to feel 23 yrs old on the back of ourskidoo in Labrador. Smell is such an evocative sense isn't it? I went for a walk after work tonight (clearing my mind after wild child afternoon aka well baby immunization clinic) and the 5 pm sunset was beautiful, even at -16c with the wind chill. 

One of the good things about working in a more relaxed northern setting is laughing WAY more than in a traditional 'southern' workplace. For example, as the A/SHP (acting nurse in charge) and I were standing outside the pharmacy door, one of the local staff approached to say there was a lady wanting something. We both heard "she wants some NIX for her knees" and responded in unison "What? Nix goes on your head!" but Edith clarified "NO, she wants some NIX for her niece". Nix of course being the treatment for head lice. The Mental Health Worker was explaining that he led with the things no one wants to talk about "hi I'm Femi, I'm 55 years old and I weight 220lb. now that we've got that out of the way we can get along". I explained that I wasn't telling anyone how much I weighed, but my age wasn't a problem. I am the STI (sexually transmitted infections) nurse - meaning I'm supposed to be testing, treating, tracking down contacts then doing test of cures. I was discouraged to find last week that there were enough new cases of STIs that I would need to take my socks off to count them, couldn't just use my fingers. There were several cases of 'the immaculate chlamydia' where married couples each named only the other partner as their sole contact…..ummmm I don't think so. On Monday, when I was first call (the health centre is closed for lunch and first call nurse puts on the answering machine and takes the cell phone home) I received an emergency call wondering if anyone wanted to buy sealskin kamiks. A coworker had a call from a rather slow person who babysits and she was describing the child's sore throat, when she was told to "come in to the health centre" she said "should I bring her?" Ummm yes I think so as she's the one you're calling about. It's not all fun and games as I got 1 hour and 45 minutes of sleep (not consecutively either) on Thursday night and had to work the following day. Mind you, Rosie the CHR (community health representative) often makes us bannock fried in a cast iron frying pan and served warm with jam at the end of the week and so we've come to look forward to Bannock Fridays. 

We of course, as any employees do, look forward to paydays, especially those of us who haven't received a direct deposit since July. I am never impressed when I see the amount of income tax deducted but if I'm doing well enough to have that bother me…'s a first world problem. We have been working short so with fewer nurses the call is closer together and it's been fairly busy so... lucrative. Next week with additional nurses arriving we'll be down to one in five. Since we're on the topic of the filthy lucre I should mention that I was casting about for various employment options and discovered that the agency nurses are paid according to the size of the health centre + a standard per diem. This translates to $650/day for a CHN in a two nurse centre, $620/3 nurses and $590/5 nurses per 24 hr shift (callbacks aren't compensated) which is comparable to the $600/day which my ACP (advanced care paramedic) buddy earns on contract in the oilfields. I have at times considered doing OHN work there as it sounds equally lucrative. I have applied for an 8 wk job share position in a small (140 souls) hamlet in NWT but am not sure if I'll go through with the process as a colleague tells me the pay will be about half of what I'm earning now. And speaking of money and contacts…. my roommate committed to a 9 wk contract over Christmas and her hubby (who was going to join her for 2 wks) can't get Aeroplan flights in - would cost over $4000 to get in and out from Ottawa. I haven't dared ask what their plans are. I know her long term plans include working in remote BC locations vs coming back here. 

It's not as if I am without non work activities to fill my time. As I mentioned to my roommate today "your knitting is coming right along" and she replied "about the same as your crocheting". Meaning neither of the projects had been handled in any way except to move them from one side of the coffee table to the other. I did read a book I found in the nightstand entitled My Mountie and Me which was not even a long publication and have made a thank you card from my scrapbook supplies but….only one. 

I am at present procrastinating from doing my pre-course assignment for the Diploma of Tropical Nursing course that I'm attending in about a month. The multiple pages of the over one dozen readings (381 page books, 165 page PDF documents and 18 page articles for example) are barely begun. One additional chore will be learning to use the Harvard referencing system, which in all the studies I've done is not one I've used (of course). I was eating my lunch and reading about worm burden (only a nurse can write that truthfully) this weekend and realized….this is a LOT of work….what was I thinking? I am using flash cards I've created with the various worm names on the front and I am sure there will be lots of discussion about EVD (ebola virus disease) in Liverpool as many of the lecturers at the LSTMH work in the field in Africa. I have decided as I watch events unfolding in the media that fear-bola is worse than ebola itself. I've tried to review a couple of webinars but those will have to wait until I'm in a location with more bandwidth. I ordered the two course textbooks from Amazon and they should be delivered this week at home. I did however register online for the University of Liverpool and uploaded a photo - likely will look like one of those distorted mirror shots by the time they get in on an ID tag. I am not concerned. My roommate was looking at photos of fruit in a third world food market and I told her the rule is….peel it, cook it or forget it….and she said "the lettuce looks great" and I screamed "lettuce and sprouts are THE worst" and she sighed and pronounced "this course is really twisting your mind". Now that I'm not arguing with. 

The physician, her husband (who has been substitute teaching here) and their dog flew out today. They'll be back here in February for another locum but we already miss her. One of those great Dr. you not only trust but like and yes you can have various combinations of those two descriptors. When the little guy we delivered arrived for his well baby checkup as he was home from Yellowknife yesterday she had us take her photo with him.  Nice to have someone like that be on the other end of the phone when you have to call for help. 

So….I must get my act together and read another article as tonight I'm not on call and the days are slipping away. 

Wednesday, October 15, 2014

Snow machine season

Hello? hello? Can you hear me down south from up here in the great white north? Oh good, then let me fill you in on the past 20 days. As you have deduced….I have arrived in Kugluktuk and am all settled in. Well, as settled in as a transient person can hope to be. It's been a busy start of up most of the night on calls, extended waits for a medevac flight, long weekend days of call after call and frantic clinic days. 

Sharing a chair
Started out with a gastro bug that went through the community and although I'm almost certain it wasn't noro virus, just a regular tummy bug, there was a LOT of drama. As in….falling on the floor screaming in front of the front desk, being found lying on the floor of the entryway to the health centre, groaning so loudly that office doors must be shut to hear answers to assessment questions, yelling "I need an IV" and then further questioning shows they vomited once four hours ago. There were votes by nursing staff as to who should be awarded Oscars for the best performances. Since the gastro bug has moved on, we are now seeing lots of respiratory symptoms. Colds and coughs with those who think they have pneumonia (usually the smokers) or the frequent flyers who don't hesitate to come see a nurse (most often outside of regular clinic hours) with a VERY well child - the one running up and down the halls with the other kid who is waiting for the dentist, or the one tearing your office apart. Often this happy, smiling, squealing child morphs into….evil kidlet. Screaming, lying on the floor or running around the office, clamping two hands over their mouth (they already know where you're going to examine) requiring both parents to wrestle them into a partially submissive state while you attempt to see eardrums and tonsils on a moving target. And don't get me started as to how you auscultate breath sounds in such a situation. These two lads above were very cooperative but they were just hanging out with someone else, not actually needing to see the nurse. 

Have had a run on human bites (very nasty) which have required aggressive antibiotic treatment, some opening of wounds to explore and some partial closing of a large deep one - had to get the Doc up one night to put an upper lip back together as it was a full thickness (through to the inside lining of the mouth) 3 cm x 2.5 cm ragged gash - have never seen a human bite like that in my 40 yrs of nursing. Apparently teeth have become the weapon of choice. I'm purposely not including in the stats the four toddler boy victims who came in over the past two weeks from the preschool - I'm thinking the female biter has been dealt with (root cause analysis) so the visits have ceased. 

I'm the STI (sexually transmitted infection) nurse here this contract and it's a busy portfolio. I knew that from my previous gig last year and still switched for it with my roommie - better the devil you know…There is a three inch binder of two page forms in a community of 1420 souls since……July. We should just test everyone at every visit. It does help that I enjoy doing family tree work when you're doing contact tracing. You can tell if someone is frequently treated if they say "where are the pink pills?" referring to the zithromax which from another supplier is now issued in white. Hmmm, I thought that too when I opened the bottle but wait…'re not a nurse! I am determined to get a handle on the status of the program - who tested positive? is the treatment and contact tracing done? have they had test of cure after 4 wks? are the reports / results faxed to the communicable disease coordinator? STIs are reportable and syphillis is making a comeback. Clearing using a small shovel to put out a fire but just stacking the lab reports in a pile (as I found them upon arrival) is not helping. I find that I do remember some people from my last time here - that is not usually a good thing as it means they were either sick, badly behaved or both. 

A lot of the frustrations are mediated by having a good roommate - my demographics - who describes herself as  "it's not my first rodeo". She's worked north since 2001, has a wealth of experience and has been in this community multiple times, so is a great resource. She also has a pretty wicked sense of humour, great work ethic and a good deal of common sense. Lots of organization needed here as it's a pretty jumbled spot but with an experienced team of nurses we're making some headway. We're not exactly twins though as she is a vegan and is now eating some kind of weird Gwenyth Paltrow regime to fit in to a very form fitting dress she bought for renewal of vows ceremony in Bahamas in December. Myself, I am of the school of thought that if you promised 'till death do us part' once, it doesn't come with an expiry date. Mind you, they've been through a lot the past two years as her hubby is a cancer survivor and this was a promise. Her husband had post op complications and put their small dog in the kennel and it was mauled by a bigger dog, had to have emergency vet care with IVs, x-rays, exploratory of wounds, antibiotics etc (which the other dog owner paid for) and he is taking home tomorrow. So an upsetting week for her. 

I walked home tonight from work with big snowflakes softly falling and
6 pm walk home
snowmobiles whizzing by and realized that the snow which came the end of September will be here until May. Snapped a photo of a little cutie in a parka her Grannie made her. We are slipping into darkness as the 24 hr. night approaches 
and today we were an hour later in the morning getting light than NS and were dark half an hour earlier. We have been weathered a few days and had a 24 hr. delay for a medevac flight (14 mo old who swallowed a lithium battery into his esophagus 24 hrs before the mother casually mentioned it to the nurse at a appointment for herself) so we were thrilled when they finally arrived. I stopped at The Northern and gave in and bought parmesan cheese. I have searched several times through all my bags and have never found the container of it I bought in NS, packed into an action packer and zip tied / duct taped securely in. The life partner saw me pack it, although he did graciously look at home when I asked. I think it entered a Bermuda triangle somewhere. 

Had a brief chat with my tropical nursing course classmate as she has decided to rent a vehicle for the first two weeks of our UK adventure - I told her that she was in charge of the social arrangements and I will contribute my half.  Trips to Cambridge, Oxford and Leeds fill the weekends and we have the Beatles Museum and some pub visits on the agenda. So many choices, so little time. We heard from the accommodations in Liverpool that we can stay for the three weeks for a total of $665 Cdn in a residence with private room and shared kitchen / bath i.e. nurses residence which is a two min. walk from class. Less than six weeks now, so getting excited. Or at least I was until I opened the email LSTMH sent today with the pre course assignment (16 pages of instructions). We have a month to get it done. I will start tomorrow……perhaps. 

When my travel classmate asked how long I was home for I explained that I arrived (hopefully with weather etc) on November 21st and we leave for England on Nov 27th but….I am going to the Bob Seeger concert in the city on November 24th with a buddy (first day of lobstering so no music for the shore captain). She said "oh don't tell them in England about Bob Seeger they won't think you're cool". As if they would anyway? Made me giggle. 

Am closing with a photo of the Heritage Visitors Center which is shaped like an ulu (women's knife) and houses some exhibits. The link below is a great local resource. Will attempt to to get in there before I leave. So, you're all caught up to date and I'm heading to la la land.