Saturday, December 22, 2007

At your service...

After a bit of a sleep-in, then a trip to the hospital to round on our inpatients, and a stop at the Frobisher Inn for a coffee at the Caribrew Cafe*, Aaron and I headed to Northmart to do some grocery shopping. We had almost filled the grocery cart, and we were browsing the section of the store that sells fox and rabbit furs, when I heard a loud "beep-beep-beep".

My first thought was, "Oh no, Aaron will to have to go on a Medevac and he'll get stuck up in Igloolik for Christmas." Then I realized it was my pager going off (I'm not on call today, but was wearing my pager anyway). I looked at the very familiar number on the screen, and walked about 5 feet over to the pharmacy counter.

I showed the pharmacist my pager and asked, "Were you calling?" He looked at me like I was a crazy person, and then I said, "Oh, hi I'm Dr. H." I must talk to these guys about 5 times a day on the phone, but I've only met a few of the people who work at the two pharmacies in town.

He looked very surprised and said, "Well, I have to ask about a clarification on a prescription." We looked at the script in question together, and quickly resolved the issue. Aaron was standing behind me with the grocery cart, and said, "The doctors are providing some excellent service in returning pages these days!"

I think I may have set a new world-record in "timely return of a page". Yet another benefit of practicing rural medicine!

*the highlight of sitting around drinking coffee at the Frob today was seeing Polar Man! I guess even super-heroes need some caffeine. It's been a while since I've seen Iqaluit's resident do-gooder. I think he might have been walking through town with the Christmas Parade a couple of weeks ago...other than that, the last time I saw him was at the museum last March when I was up visiting Aaron. All I remember about that encounter was having a very surreal conversation with a guy dressed in a white sweatsuit and a full-face ski mask, who was snacking on bannock. Who knows when our paths will cross again, Polar Man?

Sunday, December 16, 2007

All dressed up with some place to go!

Earlier this month we had a chance to go to a charity ball put on each year here in Iqaluit by First Air. For those who've never travelled in northern Canada it may come as a surprise that there are literally dozens of airlines you've probably never heard of shuttling people between the south and the north, as well as between northern communities. As one Inuit elder told me 'The Inuit people are still nomadic, these days we just use airplanes instead of dog-teams.'. His comment was partly in jest, but travel by air is a normal way of life here in the Arctic, and the business of the small airports up here reflects that.

As one of the biggest of the northern airlines First Air has a few major initiatives to give back to the communities it serves. The First Air ball is one of those initiatives. The money it generates goes to a number of important local charities (including the Women's Shelter which is an excellent organization and very underfunded). It's a big dinner and dance, where everyone dresses to the nines, and each table has a local celebrity (from the premier on down) to provide stimulating conversation. Like any good small town event it's held at the arena ( what used to be an arena before the floor somehow malfunctioned and made ice-making impossible). There was a great band, flown up from Montreal (I guess when you are the airline you can fly up who you want) who played hits from the '80's til the wee hours.

It was a fun night to cut loose and forget the worries and stresses that go along with medical practice. I can now also say with some certainty that although Nunavut has a small population, I will back our premier in a dance-off against any other province's premier, any day of the year....

Here's a pic from the event...

Monday, December 10, 2007

Northern Images

Colours on the ground. Photograph by Dr. H, Apex Nunavut, Fall 2007

Saturday, December 8, 2007

A White Christmas

One certainty when you live in the arctic is the promise of a white Christmas. We've had snow on the ground for almost 2 months now, and winter has a firm grip on Iqaluit. So far it's been a lovely winter here with temperatures warmer than usual, averaging -10C to -15C. It's nice weather to walk around in, though the warm temperatures have brought a little more snow than usual, and the ice on the bay is still not thick enough for safe travel. I understand from watching the CBC news that Southern Canada has been suffering through a dreadfully cold December and is looking at a colder than average winter (incidentally the temperatures there have also been in the -10 to -15 range).

The hospital is decorated for the holidays and we put up a small tree at home to bring some holiday cheer. Since we're way above the tree-line it's a fake tree with fiber-optic lights (it's sort of like a cross between a pine tree and a discoteque). Regardless, it brightens up the house and feels Christmas-sy. We have a lovely seal-skin angel to top it all off.

The small town Santa Claus parade is an event familiar to anyone who grew up in a non-urban environment. Everyone in the town is either in the parade or watching the parade, and the parade itself is mostly composed of any truck in town that has flashing lights. The Iqaluit Santa Clause parade started just outside our house at the Arctic Winter Games Complex, and we had a great view from our back porch. I'm happy to report that Santa did make an appearance, after all it's only a 25 minute reindeer flight from his place...

Saturday, December 1, 2007

Appropriate Apprehension

There is no more sickening feeling then looking down the blade of a laryngoscope and not seeing the airway, repositioning, attempting secondary maneuvers, and still nothing. Except perhaps the sight of the just delivered head of a baby suck back against the perineum in a severe shoulder dystocia. Or maybe a newborn baby, flat and blue and not responding to artificial ventilation. It makes the pit of your stomach drop. The feeling is sickening. These are cases that cause prudent people apprehension to even consider. In the seconds before repositioning the laryngoscope works and the airway slides into view, before the baby's shoulder disimpacts and delivers, or as another baby gasps it's way to a 5 minute APGAR of 9; these are the moments where the specter of that sickening feeling sits on your shoulder and waits to slide it's hand onto the back of your neck.

Medicine here in the north is a proposition that calls for interdependence between doctors, nurses, ambulance crews, flight paramedics, and interpreters. To practice you need to be able to trust that the other people in the team know what they're doing and will make good decisions. Although confidence can be a marker of an experienced person, in some situations it can also be a red flag. As a Family Medicine resident, one of my teachers told me that every grey hair he had was from a delivery (he was an experienced doctor with over 30 years of obstetrical experience, and a head full of steel grey hair, and always walked into a delivery with a deep breath preparing for trouble). If the specter of apprehension doesn't visit you as you walk into the case room to do a delivery, you simply haven't done enough deliveries to know better.

I once took a phone call from a very nervous nurse in a remote community who was taking care of a child who had stopped breathing. I talked her through bag masking the child, putting in an oral airway and an orogastric tube, and ensuring she had a good seal with the face mask. She was well trained and did fine, but even as the situation moved from chaos to control she worried: 'This might end badly'. Indeed. Appropriate apprehension. I arranged for a medevac, and felt that the pediatrician should go along to intubate the child. The flight medic disagreed: 'I can intubate kids, no problem', he told me, 'I've done it lots of times. You don't need to send a pediatrician' The temptation was to take his confidence at face value, to feel relieved that an experienced manipulator of the pediatric airway was on the case, and flying to the rescue, but instead the pit of my stomach dropped. I know people who intubate kids (Dr. H. among them), and it seems that the more children's airways a person looks in, the more cautious they become. Things can go wrong, and there is a marked difference between being able to handle the situation as long as it goes well, and being able to handle the situation.

Perhaps one of the most dangerous things that can happen to a young doctor (or nurse, medic, etc.) is to have everything go right early in their career. It blurs the line between the confident and the cavalier. Complications breed apprehension, but also strategies for coping with future complications. In an isolated place, where things can go wrong quickly, and help is limited, confidence can be misplaced and sometimes apprehension is simply a marker of good experience.