GEN’S ARCTIC ADVENTURES

I’m losing count of the times I’ve sat on a plane with my heart pounding, wondering why I hadn’t just stayed at home and kept things status quo. I’m not even entirely sure how this happened – the result of an impromptu phone interview for a job I didn’t remember applying for. I said yes to the interview just to see what the job was about, telling myself it didn’t matter, and still watched my heart rate skyrocket on my FitBit as they grilled me for an hour.
“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.
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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?”
“Uhh…pretty nervous.”
“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.
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“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.”
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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.

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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.

Shit.

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.

DAY 6