We saw the pine beetle damage from the sky. Fields of orange, with patches of green. A black bear runs underneath us, not bothered by the loud whir of the Cessna’s engines.
Some more fuel and we keep going, keep going into nowhere. The gravel runway feels smooth under us. Everyone piles out, but we linger as the plane is unloaded. Carefully, an immaculately iced slab of birthday cake is extricated from amongst the cargo. With it come the bags of mail, the medical supplies, some boxes of dried goods for the store, and a few duffle bags. All the pickup trucks are lined up at the airstrip’s edge, waiting for us. My too-big for the time we are visiting shoulder bag looks silly banging against my leg as we unload into the clinic.
The health station is well-equipped despite there being maybe 400 people in the surrounding area. Things I haven’t yet learned to use fill the cupboards or sit quietly plugged into the wall with lights flickering. Patients come in and out with the usual aches and pains, coughs, and worries. The patient asking for her depot contraceptive is a few months overdue for an appointment. And, apparently, her period. She’s pregnant, and it’s not wanted. I’m a little out of my league. Having seen only a bit of big city Family Practice, my summer rural rotation is the first time I’ve been elbow-deep. My preceptor has taken me to this place. This is the place he visits once a month, probably because no one else will. My first patient here is on the receiving end of one unsure medical student’s attempts to do a good job: “Uh. I’ll be back in a second. Just have to get the doctor.” He listens as I wonder “Is it normal to do a pregnancy test before giving the depo shot?” He explains that this is a special population that sometimes require a different approach to care. “Errr, I guess, uhh, she’s pregnant. How do I, er, uh, what do I say?”
The nurses don’t last more than a few weeks usually. They try, they work hard, but it’s too isolated, too frightening. There’s nothing for the people to do here except maybe bingo at the community centre. Some hunt or fish but that’s no longer common. In their free time, many residents spend time hurting each other, attempting chemical escape, or trying to get out to the Big City. I can’t blame ’em.
There are two ways out. The first is by plane, an option not affordable for most, though a journey can be had for free if medically warranted. Many residents here have recurrent chest pain or overdose on Tylenol. Maybe. The second way out is by logging road, a narrow one-lane winding through the brush. It requires a special radio in order to report one’s position and, when the loaded logging truck is reporting mile-marker numbers closer and closer to your position, it’s time to find a spot to pull over. As the numbers wane, the grip on the steering wheel tightens. Traumas from collisions here make up the list of critical patients who – I’m pretty sure didn’t want it – win the prize of an all expenses paid emergency medical evacuation airplane trip.
We borrow a truck to do our House visits. Door to door. I’m glad the cost of the blood glucose test strips are covered for those with First Nations status. Sitting at the kitchen table, a smiling man proudly shows us his numbers. Good job! Hard to do with so few fresh veggies at the store, no variety in sugar-free products, and probably not a lot of support from those around him, but he’s done it. Next stop, it’s a beautiful four-generation family for some follow-up on one member who was quite ill. About six of the family have a cough so they might as well have a check-up beside the crackling woodstove. We chat and breathe and auscultate. Nothing too serious.
Down the road, we stop to say hello to the chief. He delights in showing us his plywood canoes – not quite the way his ancestors made them, but a beautiful craft. It is something productive, a way to keep hands busy.
There is one man we can’t find. He’s known to have hypertension but my preceptor isn’t even sure if the patient still lives around here. He might. The house he used to live in is abandoned. We drive around a bit and park at the airstrip. I get out, unsure of what we are up to but delighted that we muddy our shoes as we descend the ravine. Not a day in the office.
There he is, sitting in a plastic lawn chair under the blue tarp. A fire is going, with fish hanging above, smoking in the wind. I look around and see that he’s been here long enough to put some nails into a wood table and hang two sizes of cast-iron pans from its side.
We ask him about the fishing. Then, we ask about his health. I check and his blood pressure is astronomical. “Do you have the blood pressure pills from last time?” “Yup, right over there.” He indicates a bag on the table. They hardly rattle as I shake them. Looking inside, the pills are there. They are all there, untouched. We laugh together, kicking the dirt a little.
Looking at the grey sky and trees all around I am pretty certain that this isn’t what I have been trained to do. Organic chemistry and the pathophysiology of hemochromatosis don’t matter out here. More art than science, rural medicine never seems to be what we are taught to expect in the classroom. And if it were predictable, we wouldn’t be here. And we certainly wouldn’t come back.
from Summer 2006