Monday, July 28, 2008

A visit to my favourite little northern town

This morning, I will board a plane for Fort Simpson, a community of about 1200 people that I have visited every 2 months for the last 6years. From clinic, I drive 7 minutes to the airport, arriving at 9:55 for my 10:30 flight. (Although we have a fancy security system for flights going south to Edmonton, it’s not used for flights within the north.) I arrive in the 1-room Fort Simpson airport 45 minutes later, having been fed and watered 4 times by the flight attendant; she had only 12 passengers to look after today, and apparently a large surplus of food to dispense.

Upon landing, I retrieve the heavy metal suitcase that houses a pacemaker programmer, musing that every upgrade makes these machines heavier -- the opposite of most computerized technology. I suppose they aren’t designed for carting around the Arctic. A familiar voice begins greeting everyone in the airport; it’s Dale, the driver with a cackly laugh and a filthy truck who the bed & breakfast sends to pick me up when the hosts are busy. Dale swings my fragile luggage into the back of his pickup truck and we head down the highway, chatting about the weather, his wife’s health, and recent bear sightings in the area.

The health centre is run by a team of nurses, who provide first-line care and decide who needs to see the doctor. One nurse handles prenatal care and well-woman clinic; another runs the walk-in sick clinic, another the chronic disease program, and so on. Every few years they rotate programs to maintain skills, and each morning at sign-out the nurse-on-call presents the previous night’s cases to her nursing and physician colleagues. At morning report, new nurses receive a crash course in northern medicine: “Fred came in coughing? He needs a sputum for TB; he’s on the high-risk list. And if Joey has a boxer’s fracture, chances are that Sonny has a broken jaw; they were arguing outside the bar last night. We’ll ask Home Care to stop by his place.”

The chronic disease nurse runs the internal medicine travel clinic, and it is indeed a tight ship. Every diabetic has a recent glycosylated hemoglobin on the chart, and no one seems to forget their medications -- unlike my clinic in Yellowknife. If I ask for a blood test, an ECG and a chest x-ray, my nurse performs all of the tests herself and leaves the film on the viewbox for me to review. Any social background I request on a patient is answered by colourful stories of community life -- generally more detailed than I would like to know, but interesting nonetheless.

Monday afternoon I see patients from Wrigley; Tuesday morning includes Fort Liard and Jean Marie River, and the occasional consult patient is flown in from Nahanni Butte. These tiny communities actually view Fort Simpson as a regional centre, and some are served only by an on-site lay health worker, with fly-in nurse visits every month or so.

One of the more unusual clinics greeted me the first time I came to Fort Simpson; I commented on the number of dogs in the waiting area, and the nurse told me it was Lois’ clinic day. “Is she a vet?” I asked. “Oh no, she’s the long-term care nurse but she takes care of doggy shots and boo-boos on her days off. There’s no vet in town, and we figured she could use the clinic space once every couple of weeks.” Who was I to argue?

Lois took a turn at managing the internal medicine clinic a few years ago, and I commented that I was concerned about the social isolation of a patient I followed for congestive heart failure. “He’s so young, Lois, and I don’t think he has any personal connections to keep him going,” I commented as I represcribed his medications. She nodded thoughtfully, and a couple of months later she told me he was doing much better. “Did he meet someone?” I asked hopefully. Lois leaned forward, her eyes twinkling. “I gave him a kitten,” she told me earnestly. “He carries her everywhere, even to the grocery store. He just adores her, and she’s had all of her shots.” The thought of my corpulent patient lavishing affection on a tiny kitten made me laugh outright; but I couldn’t ask for more holistic care.

A few years ago, Fort Simpson was blessed with a remarkable physician who served the community half-time, spending the rest of his year at his family’s ranch on Salt Spring Island. Shane invested heavily in nurse education, and the bulletin boards in examining rooms are covered with the protocols he wrote up for the diagnosis and treatment of common conditions. Strep throat scoring systems, first-line therapy for UTI’s (including who needs a culture), antibiotic protocols for cellulitis, and prenatal visit guidelines jostle for space among various notices from the Yellowknife specialist clinics.

Among the protocols is a tiny scrap of paper titled “the internist”, with my cell phone number underneath. Apparently Fort Simpson doesn’t consult the call schedule; and in truth, I would rather be the one to find out if a familiar patient runs into problems. The doctor’s office even has a photo of “the internist” with her jolly redheaded baby, enjoying a holiday in the south of France. Jeannine, the nurse who runs the bed & breakfast, always stops by to chat or offer me a drink after clinic. And if I still lacked a sense of social belonging, in my favorite little northern town, I’m sure Lois would find me a kitten.

1 comment:

dd said...

this is only to tell you that you have a reader in Barcelona (Spain). I have found your blog most interesting!
thanks for doing it.