28 Hour Socks

2008
Copeland, Joseph E.

 

I know, I know: you’re not supposed to wear your socks for 28 hours. In the polite world, in the southern world, in Vancouver or Ottawa or Montreal, you don’t do this. You put your socks on in the morning, you go to work, and at 5:00 or 6:00 you head home to take them off. Maybe you even put your feet up, read the paper, relax.

But this is not the polite world. This is full-service Family Medicine in the North - the unpredictable North, the exciting North, the exhausting North. Sometimes you don’t get to change your socks so often.

When I headed to hospital yesterday morning at 8:00, I was expecting a straightforward day in Iqaluit, Nunavut’s capital: round on my inpatients, clinic 9-12, quick swim, clinic again, and then a few hours off before overnight duty.

Then at 11:30 the call came in to the E.R.: 13 year-old Inuit boy, skidoo accident with closed head injury, waaaaay up in Pond Inlet. Time for another medivac, and first doc on the list was me. I changed into jeans and hiking boots, and grabbed some heavier winter gear. It was only hour number four for my socks.

The paramedics picked me up at the door, and we headed for the airfield to pack up rescue gear. The pilots got the weather reports and flight information for the 2 1/2 hour trip north of the Arctic Circle.

The King Air 200 is a dual prop aircraft, capable of carrying 16 passengers, but reconfigured in this case with two jump seats, a bench seat, and a stretcher. I’ve been on them before but never as the attending doctor. Co-pilot Llewellyn briefed us on the two emergency exits, and mentioned that emergency rescue gear was in the pod.

“What’s a pod?” I asked. ‘It’s the cargo section in the underbelly of the plane’, she replied. “How exactly would we get at it after an emergency landing on the tundra?” I asked. ‘Well, the plane would probably break apart, and the gear would be all over’.

Great. So we’re in a flying piñata, full of survival gear. At least we have plenty of morphine on board to ease the final hours…

One other passenger came along on this trip-John, a paramedic from British Columbia, with plenty of experience under his belt. It’s been awhile since I’ve had to manage a skull fracture up here, and this was the first time I’ve had to take into account the problems of turbulence, altitude, and propeller noise. I was happy to have a second person coming with me as we left for the high Arctic. We missed lunch, but at least the weather was clear. I took off my boots and let my still-fresh socks air out.

Mittimatalik, Pond Inlet, is one of the places in Nunavut renowned for its beauty, and breaking through clouds en route to the gravel airstrip you can see why. “This year’s iceberg” was still frozen into the harbour, and the snow-capped mountains that form the backdrop to the town were stunning.

At the health centre we arrived to find a pretty sick pup: unconscious, obvious head trauma, occasionally awakening and fighting the nurses. He was protecting his own airway, though, and occasionally trying to sit up, hollering in Inuktitut, before slumping down on the stretcher. This was going to be a challenge. I needed to get this kid sedated and immobilized, but hopefully not so deep that we’d have to intubate him for transport. I don’t like to intubate obese 13 year-olds with possible skull fractures. Nope.

Doctors in the south may complain about strained resources, but from Pond Inlet the nearest CT scanner is more than 5 hours away, by plane.

As we got the patient packaged up, with better IV access, a rigid neck collar, and so on, the nurses asked me if we could take a woman with a possible ectopic pregnancy, too. There wouldn’t be another scheduled flight to Iqaluit for two days. The pilots had to assess weight and fuel requirements, and I had to get a handle on patient #1 before examining and accepting patient #2. Two unstable cases on board and you might find yourself up to your ears in alligators at 20,000 feet.

Ultimately we got everyone on board, and made arrangements to have a plane from Ottawa come up to meet us in Iqaluit, so the kid could get to an urban ICU. Ready, steady, zoom.

On the trip to and from Pond, John and I talked a lot about life, work, and the challenges in this place. We both have mixed feelings about the changes in the North, and what the arrival of things like skidoos, alcohol, MTV and junk food mean for Nunavut. No living culture is static, and you can’t expect Inuit Canadians to be out hunting and fishing in sealskin coats all the time, but I do wonder if we’ve done any favours by bringing in the bad bits of southern culture. Antibiotics: good, Doritos: bad. There is so much still to be done here.

Well, we arrived in Iqaluit in one piece, and the head-injured patient was relatively stable, with the help of frequent sedative top-ups. Though scheduled to start my 12-hour ER shift at 20:00, another doc covered for me while I finished up with trauma x-rays, blood work, etc., and got the patient safely off to the south. My socks, meanwhile, were a little sweaty, at hour #16.

From midnight to 3:00, I managed the E.R. and the wards, busied especially by a onemonth- old with frequent apnoeic spells of 30-90 seconds at a time. This made the nurses very unhappy. This in turn made me very unhappy. My last E..R. patient arrived at 3:00, just as day was breaking. No rest for the wicked.

With everything finally quiet on the wards, I headed to the call-room, still fully clothed, to try for some shut-eye. Time in socks: 19 hours.

Mercifully, I was able to sleep from 4:00 to 8:00, a rare and welcome miracle. Then it was rounds on my patients, calls to my assigned community “up-island”, handover of any unresolved issues, and straight to the pool for that swim I’d missed the day before.

It had been 28 hours since I’d left my apartment, still in the same rumpled clothes.

OFF WITH THE SOCKS!

Now it’s 2:00 p.m., and I’m home, showered, and shaved, with clean, dry feet and ready for bed. There’s more to do, at work and away, but it can wait. Tomorrow we bid adieu to one of the long-term docs, with a dinner at one of the few restaurants in town. If I don’t get called away on another flight, I might even get some rest.

I always said I wanted to be the kind of doctor who could handle whatever walked in the door, and you couldn’t ask for more. Family Medicine in the North encompasses everything we hoped and trained for: challenging, multilingual, cross-cultural, cradle to grave, acute and commonplace, and never, ever boring.

Note to self: bring more socks.

See you soon,

Joseph

Theme: Community | Communauté
Theme: Health Care Delivery | Prestation des soins de santé
Theme: Patients | Patients

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.

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