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. 

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.

http://www.readersdigest.ca/travel/canada/7-surprising-facts-about-life-nunavut

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

JANE GEORGE

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!

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.

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. 

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

Are you in Cambridge Bay? I sure am!

It took me the weekend to get here but yep, I am in Cambridge Bay. Had a little birthday get together on Friday and enjoyed the company of some good friends and the junior captain and his girlfriend. The younger couple was a real score as she is very shy and he is socially challenged with mature guests so it was nice to spend the evening with them all. Of course I was too keyed up to sleep so I tossed and turned for a couple of hours and then gave up, said goodbyes to the kitty boys (who ignored me) and the dog (who was all confused as I woke her up to do so) and was off to the city. Woke up the teacher daughter and she drove me out to the airport. Had a good nap to Toronto and then again to Edmonton. Lots of tradespeople making their way out west for the first time (excitedly) or one of many trips (a bit more reluctantly) over the past few decades.

Was met by the western daughter and we headed off for our day of adventure. Began with a trip to the Old Strathcona Farmers Market, then had a wonderful lunch at a Persian restaurant, off to Canadian Tire to purchase an Action Packer and then to Walmart to buy groceries to put in it. By the time all those errands were run we had a late supper at the Royal Executive Inn and crashed for the night. An early morning and a short jaunt over to the airport. It was sure great to have the help of a very strong woman as well as celebrating our mutual birthdays.

A check in at the airport with my luggage and oversize container - found a teacher who was heading in to Cam Bay for the first time as well and then a slight delay as we waited for First Air which thankfully didn't result in missing the connection at Yellowknife, as my newly acquired travel mate and I were hearing the boarding announcement while walking into the terminal. Directed through a small room which contained both Canadian North and First Air desks and then out onto the tarmac towards a turboprop. It was a 20 seat plane with lots of cargo up front. "Oh, I thought there'd be a larger plane" my travel mate says while I'm thinking to myself  'actually this is pretty good considering what I was expecting'. We settle in and the (only) flight attendant serves us the second breakfast of our day, offers us all a bottle of water and a newspaper, then retires to the last seat to read the paper, check her photos on her phone and generally have a lengthy break. After leaving the trees we fly over vast areas of tundra and lakes then open seas and shoreline before heading down to Cambridge Bay. New experience to land on a dirt airstrip in front of a very tiny airport.

At the terminal (with a muskox statue or stuffed I wasn't sure) in the window, I was met by the Nurse in Charge. My luggage all arrived on the belt and we headed into 'town' in the mud encrusted Health Center SUV past boats in the harbour, 4wheelers on the mucky streets and typical northern buildings. Very nice apartment which I have to myself for a couple of days before another transient arrives, nurses apartments are next to the Health Center so most staff go across for lunch. Got my stuff unpacked, headed over to the Coop for perishable supplies, made a batch of biscuits, fixed myself some supper and called it a day. Figure the place is pretty well set up if the only thing I put on my list as missing is a pastry blender.

In to the Health Center this am and it is a lovely new facility, well set up and provisioned, staffed with very friendly, experienced nurses - most of them from Newfoundland - they run Nunavut. It was a busy day here, working short, overbooked, lots of walk ins and a medevac - reminded me of my previous life. My head is about to explode of course. VERY different way of nursing - I am used to immunizations, and have done SOAP (subjective, objective, action, plan) nursing notes, and the charts will be ok when I get used to them but thinking about prescribing (and dispensing) drugs, ordering routine and emergent labs and xrays (Meditech has followed me here in a new and more unwieldy form arrghh) consulting physicians and specialists, doing on call and most of all finding things has made me feel very lost (of course) as I don't even know what I don't know yet. I am about to wrap this up to study one of the many 'manuals' so I at least will know what questions to ask to begin with. My nurse mentor is kind considering they are really short this week. They have 3 F/T nurses and casuals who float through to fill the other spaces as there should be 5 nurses here. Have a Dr, lab and DI, midwives, ultrasound comes in, consultant clinics -  Booked patients in the morning to a max of five each, afternoon clinics such as Well Child and lots of teamwork. Extensive social problems, substance abuse and mental health issues as well as a very young population so lots of babies and children, very young mothers, a challenge with the local accent and names and more. My goal is to survive the experience and hopefully not screw up too badly.

I have been making attempts to connect to the internet and although I walked over in the snow (yes it snowed for a few hours here this afternoon) to Polarnet and gave them $215 of my money it was to no avail as my MacBook Air doesn't have a port for an ethernet cable. Doesn't pay to try to be too sophisticated in the north it seems. I will know for next time (if I survive remember :) ? And for those looking for me on FaceBook, now you know....the rest of the story. So, I am heading back over to the nurses residence to crack those books. Will post as the week goes on. Is it only Monday?