I’m a homebody who has never pushed myself out of my comfort zone; never done anything really exciting with my life. I’ve supported many endeavours financially, wishing friends, acquaintances, and various groups well as they embark on humanitarian efforts around the world, but I’ve never gone myself. I’ve helped raise donations, and I’ve cleaned and catalogued donated medical equipment, but I’ve never traveled with it. I’ve read email updates and blogs, cheering others on, then listened to stories of adventures upon their return home, but have never had stories of my own to tell. As a matter of fact, as I write this, an AMAZING medical team is in Ghana and they are making real and lasting differences in the lives of thousands who attend their clinics.
This evening my heart was touched by the words of one of our nurses who has gone to spend six weeks in Canada’s north. This is not the first nurse I know who has done a ‘tour of duty’ in the north, and she’s not the only one in my circle who is there right now. The difference is that she is keeping a public blog, relating some of her experiences, and she’s given me permission to share what she’s written so far.
“Let’s say that in your community, each provider has a vehicle. There’s a clear policy that you cannot transport patients and families on these vehicles. Let’s say that a mom calls, concerned about her newborn. You make a home visit to find that the baby is much sicker than you anticipated and needs to be brought back urgently to the clinic. The mom tells you she has no way to take the baby there. How do you proceed?”
“Can I ask her family members to take the baby?”
“No one is able.”
“Can I reach out to all the neighbours to see if anyone has a vehicle and can help?”
“Everyone you can reach isn’t able to help.”
I pause. I have my answer, but I don’t think this is what they want to hear for a government job. Screw it, I think. Either they can take me exactly as I am, or not at all.
“I don’t love this option,” I say quietly, “but honestly, I would drive that baby back myself.”
“Yes! Excellent. Exactly what I wanted to hear. We have a lot of policies, and some of them contradict each other. Your patient’s safety is your priority, and you can always deal with the policies later.”
This is something I can get behind, but I almost ask her what other hard decisions I’ll have to make if she’s already leaving it at my discretion when I’ll have to break the rules.
Every time I’ve told someone that I’m going to work up North, the reactions have been similar. “Wow! How exciting. That’s going to be such a great learning experience! How are you feeling?”
“Don’t be! You’ll be great! I want to hear all about it when you get back.”
I’ve been grateful for all of their faith in me, but it has never really eased the pit in my stomach. There’s an unspoken rule in emerg nursing that you’re supposed to take the fear and adrenaline that make most people panic in stride. When you hear your own blood pounding in your ears, you tune it out to listen to your patient’s heart beat, the stridor in their airway, the beep of the monitors. We’re better at talking about things after – what we could have done better, what we should try next time. But we almost never talk about the fear of our limitations in the moments before.
I’m afraid of a lot of things.
I’m afraid of the loneliness and desolation of working up North. I’m afraid of second-guessing myself about everything. I’m afraid that I’m a phony running around in shoes too big for me – that I’ve fooled everyone into believing I’m far smarter and more capable than I actually am. I’m afraid that I’m not actually equipped to do this. I’m afraid of all the unknowns.
But we don’t talk about this part. We push it aside and steady our hands as we throw in IVs, hook people up to monitors, press our stethoscopes to their chests. We pull up chairs for terrified family members and use our calm nurse voices. “I know this looks scary. This is what’s happening. This is what we’re going to do.”
We don’t tell them that sometimes, we’re scared too.
“Okay. Last question, we’re almost through. Let’s say that you’re experienced in your area of practice; you’re trusted and respected by your colleagues. But you come up here and find yourself completely overwhelmed. Everything is new and unfamiliar, and you’re exhausted. You’re trying your best, but you feel your new colleagues are unnecessarily hard on you. You have no friends or family here to turn to. How do you cope?”
I tell her the story of being a student in the ER. It wasn’t so long ago that I stood in our ambulatory zone, staring out at a sea of 40 patients in the waiting room. There was a massive stack of orders to be done, but I didn’t know how to do anything without asking for help and slowing everyone down.
You’re completely useless, I remember thinking to myself. You’re never going to earn your place here.
“But that feeling passed one day,” I tell her. “Even though for a long time, it felt like it never would.”
“And I write,” I add. “I write to make sense of things. I write to cope.”
“Good,” she says. “Remember those things.”
I feel nauseous enough on planes, and my racing heart rate isn’t exactly helping. I take a few slow breaths.
If you can remember all the reasons you were afraid to do this, I tell myself, certainly you can remember why you still decided to come.
Because I have so much to learn. Because I need to hone my skills where there aren’t other people or machines to rely on. Because I was privileged enough to be born into a safe, easy, comfortable life, and I promised I’d use it to do something for the people who weren’t.
I feel a little better as I finish this litany and put my tray table up. I take one more look at the guy in 21G who has looked a little pale and sweaty since we boarded, and then tell the triage nurse in me to please shut up. One thing at a time. Two more flights after this before I get to my destination, and I have no idea what to expect when I do.
Here we go.
I’ve just finished taking off my coat and boots when someone comes bursting through the doors of the health centre. “Someone’s not breathing!” There’s a flurry of activity as a few people haul a backboard outside to bring this person in. The four of us nurses head into our emergency room to make sure we have what we need.
The patient arrives a few minutes later, stumbling, held up by her mother and boyfriend. Breathing, walking, has a pulse. Check, check, check. She mumbles her name when I ask, but won’t answer anything else as I check her vitals. She refuses to open her eyes.
“She supposed to fly out next week to deliver, but she hasn’t been coming to her appointments with me,” Sara, who manages the prenatal patients, says. Only now do I look down and realize that this girl is heavily pregnant. Sara tosses me the fetal doppler. “Gen, can you check the baby’s heart rate?”
Yikes. I don’t do this much. Luckily, my work mom had let me practise on her just a few weeks before I’d left. I’ve just pressed the doppler against the patient’s belly when I see her eyes roll back and she starts to seize. Her mother starts to scream hysterically beside me.
And so begins our first day on call.
Seizures are always a little scary and unpredictable, and never have I had to deal with one in a pregnant woman. I’m used to having a bunch of other nurses to call in for help, at least one doctor, a respiratory therapist, and a code blue button to get all hands on deck if things go terribly wrong. Here, I have these three other nurses, and the doc on call, who is taking his sweet time to give us medication orders over the phone. There is no more back-up for us to call in.
“Can you ask him if we can draw up some ativan?” I ask Sara, still on the phone with the doctor. I have no idea if it’s safe to give in pregnancy. Judging by how long it takes him to answer her, it seems that the doc – obviously not an obstetrician – is looking it up himself. The patient starts to seize again and I grab an oral airway, but there’s no way I can get it past her clenched teeth. She’s managed to rip out her IV, so the doc gives us an order to inject the ativan into her buttocks. She finally settles for a minute, and I take this chance to put a new IV in. But I’m an idiot and don’t realize that the ones here don’t have the fancy vacuum seal that I’m used to at home, so the moment I put it in, blood comes spraying out like a hose. Whoops. At least we have IV access again.
The doc finally gives us an order for a continuous infusion of mag sulfate, and luckily, this keeps her from seizing again. But she’s so confused and agitated after her seizures that she won’t stop trying to climb out of the stretcher, and it takes three of us to continually hold her down as she swings and swats at us. When she’s finally willing to lie down, we get her boyfriend to climb in and spoon her in the stretcher. Who says you can’t get creative with restraints?
It takes a few more hours before she’s medevac’d out. The front desk staff have been sending all the walk-in patients away since all of us were tied up with the seizure, but now they’re all trickling back in. No one, it seems, is willing to stay at home with their cold symptoms, and I swear we see half of the kids in the community in one day. We scramble to see all of them, but they keep coming in. My preceptor and I, being the ones on call, finally go home at 2AM, almost eighteen hours later.
It’s a week later, and I’ve finally fallen asleep after an awful coughing fit when my phone buzzes at midnight. It’s a text from my preceptor, who conveniently lives next door.
BB having a seizure. Meet you outside in 5 mins.
The baby arrives at the health centre just a few minutes after we do. He’s a teeny-tiny thing, less than a week old. It’s the baby of the girl we saw a week ago. We check him out and he’s completely fine.
“Look, he’s doing that thing with his eyes! He’s trying to have a seizure,” his grandma shows us anxiously. We inspect him, and my preceptor laughs. “No, he’s just looking around. They can’t see much when they’re so little, so their gaze looks unfocused.”
We spend a few more minutes providing some reassurance and teaching. Grandma is understandably nervous after her daughter’s seizure last week. We help her bundle the little guy up, and tuck him underneath her coat. “If you’re worried about anything, just call us. We’re always here.”
We head home, hoping to catch a few more hours of sleep before our next morning at the clinic. But we detour to the edge of the town to see if we can see the northern lights tonight. Nothing. There’s too much cloud cover. Oh well. I think our non-seizing baby has already been our lucky moment today, and I’m happy to leave it at that.
Someone catches me in the hallway. “Hey, are you free?”
“Great. This patient has a telehealth meeting with the GI doctor. Can you sit in and take notes?” She shoves a massive patient chart into my hand.
The patient, it turns out, is a bit hard of hearing. The doctor on the other end speaks too quickly, and coupled with a lagging video feed, the whole thing ends up like a bad Skype call. I’m struggling to restrain myself from cutting in and speaking for both of them.
“Did. The. Antibiotics. Help?” the doctor yells.
“Yes, the gas is better,” the patient yells back, her good ear inclined. He makes some dietary recommendations, and then asks if she drinks.
“Yes,” she admits, “but I’m trying to cut down.
“Hmm,” he says, “it would really help your stomach pain if you stopped drinking.”
She opens her mouth to say something and then stops herself, instead choosing to stare at the table.
The doctor clears his throat awkwardly. “Well then, if there’s nothing else, that’s all for today. Call my office if you’re having more problems.”
She’s still staring a hole in the table when the doctor hangs up. I’m digging through her chart to find the prescription I have to follow up on, when she starts to talk – first slowly, and then it all rushes out.
“My partner and I make a home brew. I really like to drink. My mom was an alcoholic when she was pregnant with me, so I was in withdrawal when I was born. I started drinking when I was twelve. Social services took all my children away. I named my first after my mother…but she’s not even my daughter anymore. I keep reaching out to them, but none of them want to see me. Social services doesn’t want them to see me. My old partner – he’s sick – they flew him out to the hospital. I want to go see him, but his family hates me and they won’t let me see him. I’m not even listed on his chart. His whole family blames it on me that something happened to him.
Everyone here treats me the same. I wish I could leave this small community. And my partner here – he hits me. I try to stay busy with my sewing and Bible study, but it’s all too much sometimes. I love to party. When I drink, it’s the only time I can get away. It’s the only time I can be happy. How do I tell the doctor all that?”
She looks up at me, the tears falling freely now. “I want to be strong, but I can’t. Sometimes I just don’t want to live anymore.”
I have been a fixer my whole life. I am used to people coming to me with the things they can’t figure out and being able to tell them, “Don’t worry. I’ll take care of it.” But I sit helplessly in front of this woman as she shares her web of a life that I know I can’t fix, and all I can do is listen and be with her here.
Someone brings her in a few days later, and she’s shaking uncontrollably and completely incoherent. They think she’s overdosed on something. But we count her pills and test her urine – she took a few extra OTC meds, but nothing that will hurt her. We figure out that she’s in the midst of a mental breakdown and arrange for the mental health nurse to see her, and for family members to stay with her tonight.
I let the chaos subside and wait for some people to clear out of the room. I sit down beside her. “Were you trying to kill yourself when you took those pills?” I ask gently. She only looks at me and cries. I don’t think she knows what she wants anymore.
I’m sitting at the entrance of the grocery store the next day, giving out flu shots. I see her walk in, and she looks much better – what wonders some rest and family care can do. She comes up to me and smiles timidly, “I don’t really remember what happened yesterday, but thank you for being there for me.”
I am only now beginning to learn that I’m not in this line of work to save anyone. There are enough fixers around to be the heroes. I’m here to meet people where they are – in the messiness, in the brokenness, in the darkness – and let them know that they are seen. Sometimes, often, there are no easy answers. But maybe there is always a way to hold on to hope.