She can't hold her oxygen sats above 90% without 2L/min of O2 and is getting tired so.....we attempt to locate the Dr. who covers our community and happens to be in the hamlet this week - who is at this moment blissfully unaware at the Boothia Inn. We ring multiple times and finally let the boss know, she advises that we call the physician on call in the region. The next morning when I ask the Doc if he paid the clerk not to switch the phone over so we couldn't reach him, he denies this and says it's happened before. And it most likely has. As he says "no, I had a great night's sleep last night". My colleague and I had quickly decided though - the Doc in the Box was the better option as the physician on call in another community a few hours away (or in this case another region and two time zones away) cannot set eyes upon this baby - in this case you are the eyes, ears and hands of this professional so….they cannot really 'make you' do anything you are resistant to. As in "do you think this baby needs an IV?" "NO! she drank 20 oz of fluid in the four hours she's been here". Where as our community Doc was singing the tune of "these baby's do really well with a bolus of fluid" and the response to that is "yeah, she did really well with the 20 oz of fluid" but he wasn't convinced - this certainly confirmed that we had indeed been dealing with an easier sell. As is "can you do a chest X-ray?" "NO, I haven't done one before" which really means - and what is the purpose of that ? the treatment is probably the same and if an antibiotic does need to be started a few hours wait isn't going to change plans after a few days of this cough, the quality of the film won't likely be great, we're not wonderful at reading these and the films will go out with the patient anyway (where they will do a better one and laugh at ours) as we both know the direction this is heading, not to mention what you put a seven month old with compromised respirations through to get it. On one of my first days here when I had someone who (in a more resource rich location) would be sent for a chest X-ray and I pondered calling the janitor, I asked Nellie if she would do a chest X-ray and she says "will it change your plan of treatment?" Slight pause…."um, no" and that's settled. So after asking for a transfer, calling the medevac and giving some dexamethasone as requested by the Dr (it's in vogue again for RSV bronchiolitis) we wait for the call as to who the receiving Dr. is to get the paperwork in order.
Thankfully (for us) the medevac is out of Cambridge Bay and they're just heading in there to refuel after a transfer so will be over in less than two hours - much better than the option of waiting for one that just left some northern community and has to get down to Yellowknife and back as in the previous all nighter - but it's going to be a short night. The baby settles a bit and we check periodically as she sleeps - yes this is important therapy for a tired baby fighting to breathe - while we get the documentation in order, eat trail mix, drink mint tea and find ourselves sleep deprived and somewhat giddy as if we're doing a night shift. The first on call is responsible for the patient and stays at the health centre, the second on call is the chauffeur so we finally get the call with the ETA of 3 a.m. I suit up (snow pants, dickie, parka, hat, scarf, mitts, boots with grippers) and grab the garage door opener and keys to to the SUV and motor out to the airport to wait for them so there is a quick transition and we get to see our pillows. Let me see if I can recreate the situation for you:
I arrive at the tiny building which serves as Taloyoak Airport sitting unaccompanied on the edge of a gravel airstrip, not even a vehicle waits outside in the inky black, eyeball numbing, frigid, stillness. I leave the SUV running as at -54c it is the routine, and step away to the edge of the parking lot and the absolute aloneness of an arctic night (with the memorial to Judy Hill et al from that 1972 story) where NOTHING can be heard - no trees to crack in the cold, no bushes to rattle, not even any animals moving in these conditions. Every star and constellation in the northern sky is twinkling just for me in my solitary situation. Within a few moments a tiny star drops out of the night, touches smoothly down on the icy airstrip and stops before the flashing orange strobe on the roof of the SUV. Two men children (who are most certainly younger than my youngest offspring of almost 24) in parkas leap from the small King Air with blankets and grunts of acknowledgement to me as I introduce myself - just another nurse on another airstrip to them - and start covering the engines and wings with insulated blankets. These are to keep the engines somewhat warm, reduce wing icing and hopefully mean a quick take off. The clock is ticking. The tall, lanky flight paramedic who is known to me, pops out of the side door with the flight bags and unfolds himself down the stairs. As he gets closer I see his bleary eyed, Miami vice growth look. He tells me that they've been flying since 3 p.m. yesterday having just transported someone with premature rupture of membranes from a neighbouring community. He tells me they've done 29 transfers in the past 30 days. I sense that he shares our "let's get this party started" approach and this will be a quick turn around. Out through the gate, past the waiting fuel truck which has appeared to service the plane. Back to the health centre and Mom, baby and suitcase are ready to go. Quick check of the baby by the receiving paramedic, he calls Stanton Territorial Emerg to tell them they're on their way, mom pops baby in the pack and pulls the cords for monitor etc out the side, pops on her parka and we're out the door while I manage the O2 and monitor attached to baby. Dad carries the suitcase which I throw in the hatchback with the flight bags while he kisses mom and baby in the back seat goodbye, hops on his skidoo and heads home. We make a quick trip back to the plane and I drive up to the back door. Paramedic heads out to get the plane ready and calls back over his shoulder "I'll come back and get you mom, sit in the warm vehicle" while I help him drag the gear back. As I stumble up the flimsy steps and stand on the top one to peer into the dark, very narrow, about 5 ft. high crawl space looking like a submarine filled with equipment from stretchers to bags - I again confirm to myself that 'nope, never gonna work under these conditions, not interested in this being my workplace' and back out and down to the ground. The paramedic appears shortly behind me wearing a head lamp, assists mom and baby from the back seat - I wish them well, then they're up the steps and I drive around the plane while heaving a huge sigh of relief, out through the gate and back to put the vehicle away. The coworker and I are up the stairs in a flash as there's only three hours of sleep before the work day starts again. Am I whining? Not on your life, not a moment I regret walking away from a full time down south job. As I stood in the bone chilling dark watching those two young lads put that plane down in front of me to take a sick baby who I had helped to assess, treat and transfer out for advanced care I thought……'will someone please pinch me, I can't believe that I am really doing this, something that I have wanted to do for over 35 years since I saw it in Labrador'. I can't imagine doing anything else now and this is only my second contract.
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| Tis the season - RSV Season that is |
Clearly the poster the CHR (Community Health Representative) laboured over for the waiting room is not doing it's job. The situation has more to do with a large population under age 15, living in crowded conditions, in a harsh environment, most are anemic due to poor junk food vs traditional diet and so.....they pick up a virus and pass it around. The older kids get a harsh cough and wheeze but it's the little babies, especially the premies, bottle fed, living with smokers who are the one we worry about.....We've been doing our best to do influenza immunizations but the uptake isn't great. Now, when that wave hits maybe I'll be heading to warmer climes.
This is life in the fast lane Nunavut style. I offer it as a bit of explanation to those who ask "what do you do with all your space time to amuse yourself up there?" I could say that I read - don't you just love this graphic on the left? But I have turned the Kindle on about three times in the past month and fallen asleep before I turned more than four pages.
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| 9 am sunrise a few days ago |
The days are getting longer (and this happens more quickly here as closer to the top of the world) the sunshine is stronger, it's light from 8:30 am to 2:30 pm now. Here is a shot of sunrise about 9 a.m. I looked out the window the other morning as I made breakfast and realized that the white on white which I saw moving down over the hill was a huge arctic hare. Not only are they large, at - 54c they are tough. Hadn't seen one since I'd been here so I assumed they weren't that common, which my roommate confirmed. She says this guy takes the same route when she sees him as well heading around the hamlet.
I had a young fellow in having a pre-op assessment (we complete a basic checkup and fax it to the OR) for his orthopaedic surgery - having a wrist repaired which he injured caching his caribou in the great outdoor freezer last year when a boulder rolled on to his wrist. In the morning when I picked up his chart and called his name, he had left so when he reappeared in the afternoon I made sure to snag him quickly "you were here this morning and you disappeared, where did you go?" I asked. "Had to do something about a caribou" he replies. We then have a hunting chat as I'm doing research for the life partner who makes noises about coming up to hunt/visit me one of these years. This hunter was telling me that he hunts for caribou and ringed seal, the caribou are about 12 km outside of the hamlet, usually better in the Oct/Nov when they're fatter than in Apr/May when they're thin after the winter. I asked "how many caribou do you get a year?" He ponders the question for a while and says "I don't count them" so I press for details "do you get one, ten, one hundred?" to which he replies "maybe 12". Pretty impressive with the one deer limit in NS. When I ask if he gets any arctic hare, he shakes his head no. I draw a picture of a rabbit snare and ask if this is how they catch them and he again shakes his head no and puts his two palms out flat then snaps them closed saying "trap". Of course, there'd be no brush to hide those wire hoops in so they didn't show up in the moonlight would there? I ask why he doesn't hunt them and he tells me that they don't live out in the country causing me to say "so they're urban rabbits?" which after a bit of linguistic and cultural interpretation we agree is pretty funny.
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| Ask for help and check expiry dates |
Speaking of fur, it has become clear to me that although not shaving your legs is warmer and completely unnecessary up here as no one sees your legs anyway….it is important to put lots of moisturizer on those furry appendages. You look as if you have some kind of skin disease when you take your socks off due to the extreme lack of humidity as your skin flakes if not watered but more importantly your pants stick to you with static cling that makes it appear as if you're standing over a vacuum. Made worse by wearing those old lady stockings - support hose - and shuffling on carpet. I keep forgetting about the static and zapping folks I go to examine.
Was tickled to hear from the student nurse daughter that she'd received an A- on her latest paper. My roommate and I had contributed some editing tips so we were pleased with that! She is into the stress of the last semester of studies, clinical which wasn't even one of her choices, graduating, writing RN exams and moving halfway across the country to start a new job. Not much stress there eh?
I have given my availability of April 21st - May 24th to the GN (Gov't Nunavut) and have chosen to go to Kugluktuk (used to be called Coppermine) for the five weeks. Always want to be looking forward to the next contract before I leave this one - that's the travelling motto. My resignation for the position at home was received and some kind words from those I'll miss but how would I go back to someone telling me what to do? My roommate has landed a CHN job share in Aklavik, NWT and is instigating to get me across the border. Hmmmm.
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| Memorial to Judy Hill et al |
After reading, watching all the news of the severe winter storm and damage in Nova Scotia this week I am amazed that we've had less threatening weather at 69 degrees north. I'm off to make some muffins for the roommate as she fed me last night when I was on call. Steady parade of sick kids all day - we're running out of aerosol machines to lend out - until about midnight so not much time to cook. Today as I was second on call, I took the mental health worker to catch her flight and I caught some photos which you see here, then decided with the beautiful sunny day that it was, I would walk to The Northern Store for supplies. So, there's all the news from Nunavut - tomorrow is a new work week.
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| About 2 pm today |
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| Engine warmer |
