I've never done that before...

One of the keys to northern medicine is the ability to improvise. That means that sometimes patients ask you to figure things out that aren't in the usual physician job description. One day you might need to figure out how to use a volt meter to see if the batteries from an electric wheelchair are malfunctioning in the cold. Another day you might have to whip up a splint out of various materials around a nursing station. It's a fun part of the job, and makes you think outside of the box.
There aren't many doctors working in the arctic, but there are even fewer vets, and occasionally northern docs get asked to provide some sort of treatment to animals. Technically physicians should not treat animals, it's well outside the scope of what we are trained for, but in the absence of trained help sometimes people do what they can. There are certainly northern docs who've stitched up dogs, given infected cats antibiotics, and more. It's not ideal, but it's doing the best we can with what we have (and it is mostly in the interest of being humane rather than cavalier).
Below is an old sign from a nursing station that gives some basic medical advice for ill 4 legged friends. I'm not sure if this list ever got called into use, but it's presence in the nursing station speaks well to the spectrum of care that the health care providers in the north are asked to take on....

Long time no blog

Wow, it's been a while since I've posted anything on the blog. Luckily Dr. J is diligent with his updates and has taken some great pictures lately.

It's hard to believe that we've been back in Iqaluit for two weeks, because some days it feels like we never even had a vacation. The number and the acuity of patients has increased by a ridiculous amount, particularly the pediatric cases. If you're a doctor looking for more pediatrics experience, look no further than Iqaluit in the winter! Weirdly enough, there has been very little RSV here so far...I may be eating those words within the next few weeks, though.

I have been on for anesthesia recently, and I feel like this was a good week. We had quite a variety of cases, including a couple of more challenging ones (for me) and I felt they went well. I'm still on call for a few more days yet, so I hope I haven't jinxed myself by saying that... Now I'll be expecting a call for a stat section at 2 AM someday soon...

It's getting light outside way earlier in the day these past few weeks, which makes it easier to get up and go to the hospital in the morning. I can't wait until it's a bit warmer so that we can go do some cross country skiing.

Here's a couple of Iqaluit pictures that I took this winter (the first one happens to have a sun dog!)

See you on the dark side of the moon

The recent lunar eclipse was spectacular. It was a cold clear night here in Iqaluit, perfect for viewing.
Here is a picture of the moon at full eclipse...

You don't have to know about this...

Every Family Medicine resident is familiar with the phrase, it occurs during a discussion about the acid base status of a complex patient, the settings on a ventilator in the ICU, or during a procedure in the emerg. "Don't worry, you don't have to know about this in Family Medicine." The temptation, of course, is to turn off your ears when you hear those words. The subject matter is complex, and apparently non-relevant. Sounds like a great opportunity to do a little mental wandering...but trust me, it's not. If you're a Family Medicine resident and you hear those words, resist the temptation, and listen to the discussion, not for the sake of being a keen learner, but to help yourself down the road when the lessons learned from that discussion may well come in handy.

From the point of view of the Specialist the phrase isn't meant to be derogatory towards future Family Docs. In big cities, where medical schools are located and where every manner of specialist and test is readily available it is probably inconceivable to Specialists in teaching hospitals that any Family Doc would need to know the nuances of whatever they are speaking about. In Canada some Family Doctors will spend their whole careers working in office based practices in cities, but just as many will spend at least part of their career working in a rural or remote area where a broader set of skills is called for.

So a heads up for any future Family Docs who read the blog. If you plan on spending some of your life outside of a city (and I'd encourage you to, it's a great experience), soak up all you can while you're a resident. Listen in on the stuff you supposedly don't need to know, ask the respiratory therapist how to boot up and work the ventilator, because in the end it will pay off. When you need to know something it's amazing how those conversations can pop back into your head and help you out in a sticky situation.

Not your average beach

While we were back in Vancouver Dr. H and I had a chance to drive across Vancouver Island and spend a couple of days in Tofino. Here are a couple of pictures from the beach there. The scenery is amazing, and the waves are huge. It feels like the end of the earth, and we would definitely recommend it as a great place in Canada to visit.
We are now back in Iqaluit and enjoying cold, but sunny weather. Minus 40 really isn't that bad as long as there's no wind!

You know you're on call too much when...

So Dr. H and I have been back in BC for the past week and a half to visit. We decided to escape to Tofino for a couple of days to recharge the batteries and are staying is a nice hotel here. It's beautiful here. The waves are huge and crash against the shore with ridiculous force, the forests are still green, the air smells like trees.

Last night, at about 4 AM our hotel room was filled with a horrible beeping sound...beep beep beep...almost like a pager. By beep number 3 both of us were awake and out of bed. A quick check of our room revealed we were not on fire, and we were dressed, grabbed our day packs and were out the door immediately. In the lobby they told us there was some smoke in one of the rooms and we'd have to wait in another building until the fire department figured it all out.

What was interesting to us was the bleary eyed folks dressed in pajamas and bath robes who straggled into the lobby behind us. It turns out that being on call is good preparation for fire alarms. It also turns out that any beeping noise can wake both Dr. H and I from a deep sleep and have us dressed out the door and ready for whatever in about 2 minutes. Clearly all those on call nights are to thank/blame...

In the end there was no fire, the cause of the smoke was undetermined. Ahh well, we'll be ready for call when we get home to Iqaluit anyways!

Sorry we don't have that!

I've mentioned previously that one of the nice things about rural practice is that when you're in a jam you can 'phone a friend'. Sometimes it's a local friend, someone with specific experience that might be useful in a certain situation. In Iqaluit we have a General Surgeon for surgical consultations and GP-anesthetists for patients who need intubation or if we need assistance with critical care (that would be Dr. H). For all other consultations we make a phone call, usually to Ottawa.

Specialists in Ottawa tend to be helpful (or at least try hard to be helpful), but sometimes they aren't exactly sure where I'm coming from. 'You're phoning from where?' 'There's a hospital way up there?' For doctors accustomed to working in large tertiary care settings it can be hard to imagine that we're trying to practice medicine in such a remote environment. Sometimes their most well intentioned suggestions are simply impossible because we lack the medications or equipment to do what they suggest....

Milranone for a cardiac patient? Sorry, don't have that.
Add dobutamine to the mix for a shocky patient? Uh-uh.
Fomipazole for that guy who drank anti-freeze? Sorry, I have him on an ethanol infusion, we don't have fomipazole (although I have been agitating relentlessly for fomipazole for about 6 months now).
Dialysis? Haha.
CT-scans? Oh, my, no.
Okay, well maybe put in an arterial line and monitor the patients pressure until he can be sent out? No no no, we don't have a transducer, sorry about that.
How about a quick ECHO? Oh please.
Well, I guess just put the patient on your med-evac jet and send him down to the Ottawa ICU then? Well, we actually have to get a med-evac jet to come from Montreal then fly back down to Ottawa, shouldn't take more than 12 hours as long as the weather cooperates!

Sometimes it's a bit frustrating. Sometimes it raises the blood pressure of everyone taking care of the patient. Usually we just do what we can and hold on tight until the med-evac jet finally arrives. We do our best with what we have, though I think sometimes the specialists in the big hospitals in Ottawa must think it's all a little behind the times...