On December 30th, after 5 amazing days when I did not set foot in the hospital, it was time to head back to work. And land ourselves right in the middle of a flu outbreak. Yes, H1N1 is back, and taking over the Inuvik Hospital.
I worked two shifts in the ER last week and both were the busiest 12 hour shifts I have ever had, taking care of really sick people.
I admitted a little 7 month old baby who had a cough and some increased work of breathing. He did fine overnight, but the second night suddenly his O2 sats dropped, his fever went up, and he hadn't had a wet diaper all day. It took us an hour to get an IV into his chubby little hand but finally we (i.e. the anaesthetist I called in) succeeded, and after a chest xray showed bilateral pneumonia we started him on IV fluids and antibiotics. He still got worse, and ended up being flown to Yellowknife the next morning. 2 days later his nasopharyngeal swab came back: positive for Influenza A.
I had another gentleman in his 60s with diabetes, another high risk person for complications from the flu. He had a fever and trouble breathing and was admitted with what looked like a bad pneumonia. On my night shift in the emergency room, he suddenly got much worse and we had to put him on 15L non-rebreather mask (i.e. a LOT of oxygen) to keep his sats in the 90% range. His chest xray showed a near complete left lung whiteout - there was no air going into his left lung. He was puffing like a fish out of water, and I thought I was going to have to intubate him at 4am, by myself in the emerg. I'd even pulled up the RSI drug dosing on my phone while I was waiting for my staff to arrive. He ended up getting a chest tube to drain the fluid that was collecting around his lung from the pneumonia. His breathing got a bit better, but the fluid never totally drained, and he ended up needing a flight to Edmonton for a CT and possible surgery to crack the chest and clean out the pus from his lung (i.e. VATS decortication for empyema). His swab also returned positive for Influenza A.
So if those two stories aren't enough reason to get your flu shot each year, here are 10 others:
(for those who want to actually see a discussion of the evidence, look here: http://www.bccdc.ca/NR/rdonlyres/C5263063-8A30-4866-A6D7-AF1381C1469A/0/Influenza_prevention_policy_evidence_discussionFINAL.pdf)
#10. It's free. Who doesn't like something that's free?
#9. How cool is it that we can prevent disease? We don't have anything to cure influenza, so you can't just wait to see if you get sick. But it can prevent influenza, in 60-90% of cases. And it takes 2 weeks for your immune system to boost a full response, so for everyone who is scrambling now to get it because you waited to see if there would be an outbreak... better cross your fingers. You should have got it in November when it was first offered! Get it every year, and get it early.
#8. Influenza isn't "the flu" that you thought you had when you stayed home from school puking as your mom fed you jello and flat gingerale. That was probably enterovirus or some other unpleasant virus but not one that gives you pneumonia and respiratory failure and death. Which is what influenza can do. It's nasty. You don't want to get it.
#7. You especially don't want to get it if you are a kiddie or old or sick. Like my two patients. So if you don't care to protect yourself from the flu, get the vaccine so you don't pass it along to others.
#6. There are people who cannot get the vaccine, like babies under the age of 6 months. But if the 9 people living in the household of the baby I admitted had gotten their flu shots in the fall, maybe he wouldn't have got so sick. (The fact there are 9 people living in the same house is a different matter all together)
#5. Between 3 and 30% of healthy unvaccinated adults get influenza each year, so the risk is real. Your chance of getting into a car crash is about 25% each year, and you will still wear your seatbelt, just in case, right?
#4. An estimated 2000-4000 people die from Influenza and complications annually in Canada. Your lifetime risk is about 1 in 63. Your risk of dying in that car accident is only 1 in 84. (Just FYI, your risk of dying in a bicycle accident is only 1 in 4919).
#3. This year already, there have been 10 deaths from H1N1 in Alberta, over 300 people admitted to hospital, and 40 requiring ICU care.
#2. It just makes sense. And I can promise the government is not out to kill you with it.
#1. The best reason to get your flu shot? Because Rick Mercer says so.
I also had a brief scare last week with another infectious disease. I admitted a young guy with florid bacterial meningitis. I did the lumbar puncture, and I've never seen fluid flow so fast up the manometer, spilling over the top. It was cloudy and had too many white cells to count. For about 24hours there was some question of whether it might be Neisseria Meningitidis (meningococcus), since the lab tech thought he saw diplococci on the smear. I thought I was going to have to take Rifampin as post exposure prophylaxis. We rushed the sample to the airport, to be looked at by the lab in Edmonton. But somehow along the way it got lost in transit, was left at the airport overnight, and only discovered to be missing the next morning. Luckily, it finally arrived safely at the lab, and when we got the official report back, it was gram negative coccobacilli, confirmed later as Haemophilus influenza. The flu again (but not the viral kind, this is the bacterial kind you get immunized against as a baby - the HiB vaccine).
Between all the craziness at the hospital, we also had some time for some fun last week, including celebrating New Years Eve out at the Legion (where else?) ...
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| Happy New Years! |
We also fit in a potluck dinner with some friends. To which we brought the much anticipated "Char Tartare" - a recipe Adam dreamed up weeks ago and has been waiting for the right moment to break out.
We bought an arctic char from the Inuvialuit Regional Corporation shop that sells goods on behalf of people in the communities. This fish was apparently from Paulatuk, up on the coast east of Tuk. We bought it whole, and frozen, so we had to gut it and fillet it ourselves. Adam got creative and made half the fish into a 'tartare', kind of a sushi topping for crackers with small chopped up pieces of raw fish along with green apple, ginger, red onion, and a delicious sauce. It was amazing. The other half of the fish we filleted and baked. Also delicious. Kind of like salmon, but better.
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| The fish |
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| Master Chef at work |
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| Beautiful fillet job |
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| The finished product: "Char Tartare" |
For those of you paying attention to dates, yes we do have sun again in Inuvik! The sun rose again January 6th. But it was cloudy, and we couldn't see it. Anticlimactic. I'll snap a photo at the Sunrise Festival here this weekend though!
And lastly,
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| For everyone in Toronto complaining about the -20 weather. Suck it up. Unless you don't have power, then I'll feel sorry for you. |
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