Week 2: Here come the babies! (And the snow!)

Weather Update: COLD. Windy and snowing hard enough to ground all planes on Tuesday, so Adam was stranded in Aklavik. But not enough snow yet for dogsledding...

Sunlight count: 6h 6min (Sunrise 10:36 Sunset 16:42) … Noo! We lost a whole hour in the afternoon with daylight savings time! And now we are losing about 8 minutes of light a day.

Temperature: -20 C. Finally winter. Forecast for friday night? -29 C with the windchill. Oh yeah.

Week 2 -  I am on Obstetrics call all week, 24 hours a day for 7 days. Whenever a pregnant patient presents for assessment or in labour, I get called first. Which is terrifying. I have been dreading this for months. I like the whole pregnancy thing, the prenatal appointments, the newborn care part, but the labour part? It's boring (SO much waiting around), and terrifying (SO much can go wrong!) all at the same time! And I haven't done OB since last December, so I was feeling a bit rusty.

So, just to ease me into this, in my first 26 hours I had TWO deliveries, both complicated. Just my call karma… I was really hoping to have time to review management of FHR decels in the 2^nd stage/vacuum application/episiotomy/vaginal repairs/manual removal of the placenta/uterine atony/postpartum hemorrhage/threatened preterm labour and query rupture of membranes before I had to deal with any one of those in real life again. And they all happened within the first 48 hours. Seriously. Thankfully moms and babes are all doing well! There are apparently only about 125 deliveries a year in Inuvik, which is equal to 2.4 a week. So, I should only have .4 of a baby left to deliver!

Adam, on the other hand, went to Aklavik for a community doctor's visit on Monday and Tuesday.

This is the plane he flew in...

And is it really a surprise he didn't make it back to Inuvik as scheduled on Tuesday? Blowing snow and low clouds ... pretty glad this little plane didn't try to get up into the air in that. He made it home safe and sound Wednesday afternoon. 

Musing for the day: Making medical decisions about a patient over the phone without having the opportunity to examine them is ridiculously frustrating. I had my first daytime ER shift on Tuesday, and it felt like the phones never stopped ringing. I must have taken over 10 calls from the community between noon and 4pm. Talk about interrupting the flow of your ED!  The ER doc on call here in Inuvik is responsible for covering calls from the 7 community nursing stations in our region. The CHN (“chin” = community health nurse) will see and examine the patient at the health centre, and if they need advice, a prescription or think the patient needs transfer for investigation or management, we get called.  And we get to decide what to do, whether it be a medevac to Edmonton or discharge home, without ever laying eyes on the patient.  But what’s the alternative? Could you imagine having a phone-based triage system run by ED docs in the south to try to limit the strain on our emergency rooms? Somehow I think that liability concerns would turn it into a more expensive Telehealth/HealthlinkBC where everyone is told to come to the ER anyways.  The most difficult call yet was a 2am phone call from a nurse in one of the small remote stations who had a woman there with threatened preterm labour, contracting at 31 weeks, and she couldn't feel the cervix to know if it was open or not (fair enough, she hadn't been trained to do Vag exams!). We had to make the call to get the medevac plane to fly her down to Yellowknife since we don't have peds here and can't safely deliver any pregnancies under 36 weeks. There was some question over whether the plane could land in the stormy weather we were having, but luckily they were able and the woman got safely to hospital. And I got safely back to sleep :)

Inuvik moon-set walking home from the hospital today (6:30pm)