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Up North, Going South

May 23, 2013
The Igloo-shaped church near my apartment in Iqaluit.

The Igloo-shaped church near my apartment in Iqaluit.

I haven’t written lately. Life has been busy; a move to Vancouver, trying 3 new jobs (hospitalist at 3 of the Vancouver area hospitals), trying some new locations up north, and some academic/committee work has kept me busy. I wish I could say I’d been goofin’ off and just relaxing and enjoying summer, but that’s not quite correct.

From April 26 to May 27th, there will have been 1 (one) day that I was not either working, or traveling to work. Yes I make my own schedule, yes I am that dumb. It’s been hard to sustain eagerness and interest, but there have been some highlights.

My work on the CMA Health Care Transformation working group is really inspiring. I call it “work” but it’s really a privilege. It takes a lot for me to get really fired up about something, but the direction this group is taking is probably the most exciting thing in my professional life to date. I’ve always been interested, in fact, devoted to providing care that matches a patient’s needs/context, that is informed by the latest evidence, that encompasses common-sense, and that won’t bring harm or added cost with unnecessary tests or treatments. Now, discussions are happening at a national level about this kind of care.

We are talking about “appropriateness” in healthcare; sustainable, patient-centered, effective and evidence-informed care. We are advocating for elderly people to get the home care or long-term care facility support they deserve. We are lobbying the federal government to recognize social determinants of health, and to make fundamental changes to elevate the health status of all Canadians. I really feel that it’s a revolutionary time in healthcare in this country. Physicians, other health care providers, and patient advocacy groups are all working together towards a better system.

That said, in every place I work, I try to deliver the “best” care I can. Right now I’m in Iqaluit doing 2 weeks of hospitalist work and regional call. Everyone looks at me like I’m crazy when they see I’m doing 15 days straight, unlike the normal 8 (one day for handover). I think that my experience in hospital medicine and my drive to deliver the best care possible (that is patient-centered, evidence-informed, etc.) has allowed me to have a significant positive impact on the lives of my patients here. With pride, I discuss Code Statuses frankly (with the help of some great interpreters). My immobile, moderate-high risk patients are on DVT prophylaxis. No one is getting “daily bloodwork” just for the sake of it. The bronchiolitis kids are on the “pathway” which is basically just supportive care. My palliative patients have their symptoms aggressively managed and everyone receiving regular narcotics gets decent bowel care. I don’t have my chronic pain patients on parenteral narcotics and steer them clear of the “oxy” and “percs” they are usually already on, hoping to decrease their risk of addiction. We discharge people who will be able to manage and be more comfortable at home, and they have follow-up as needed with the outpatient clinic, homecare, etc.

It helps a lot that the nurses are attentive, knowledgeable, and seem to share my attitude; together we address the needs of the patients, make them as comfortable as possible, don’t panic, and get them home when they are safe and comfortable to do so. It has been alarmingly busy; 15 or so patients is not bad except that I also carry the pager for the region’s nursing stations, who call me with patients who have things like acute psychosis, probable appendicitis, meningitis, etc. and it is my job to give advice over the phone or to arrange to transport them somewhere that can provide the care they need. Today, I had about 12 calls. It is huge distraction from my ability to focus on my hospital work, but fortunately the nurses understand and are really patient with me.

I’ve learned a lot from the nurses and doctors who are specially aware of TB testing and management. I do struggle a little with the burden of psychiatric illness here. Our rooms are overflowing with patients who need psychiatric treatment and our mental health nurses work their butts off to arrange the care needed. I defer a lot to their expertise and add what I can, when I can. Even just a daily visit to a profoundly depressed or marginally psychotic patient seems to go a long way to helping them feel human, and it’s rewarding to see them improve from day to day.

Being a locum, bouncing around from place to place, one rarely gets the benefit of continuity of care and connections with patients. I am pleased to say that I have had that here. I’m so so tired because I’ve just been working too much. But even at the end of the day when I’m tired and hungry and grumpy and a migraine is setting in, I leave the hospital satisfied that I’ve done my very best. And sometimes people notice too, which is not necessary but it does feel pretty good.

A beautiful gift from the granddaughter of one of my patients, with thanks for my care. This is a print of a scene from Arctic Bay, NU, my patient's home.

A beautiful gift from the granddaughter of one of my patients, with thanks for my care. This is a print of a scene from Arctic Bay, NU, my patient’s home. Now that was a kind surprise!

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