Working at a small hospital in the north can be both exiting and an experience. If you appreciate nature and trees, it can be a stress relieving. One major problem is the isolation. At times the bush seems to crowd you and you can't breathe.
Shifts can be long and boring or you can be run off your feet wishing you had ten more arms and legs.
Our hospital was a twenty bed newer building and fairly active. It was the only hospital for miles and served a varied population. Our units consisted of medical, obstetrics, pediatrics and minor surgeries and of course an ER. We also offered chemo-therapy for cancer patients.
We were fortunate in the fact that we had two doctors who called this small northern town home. The only time we were without both of the doctors was when one of them went off to workshops. We also had a visiting orthopedic surgeon on a monthly basis.
As assistant administrator and director of nursing, some of my responsibilities were staffing, scheduling of appointments, supplies, ordering and keeping track of all medications and working the units and emergency department if they became busy.
The following are cases from my journal of my time spent in the north.
Air ambulance - cont'd
As the nurse and driver arrived at the plane, the patient was brought down to the tarmac and placed on the stretcher.
CPR was being done on this 45 year old lady. She had blood all over her arms, face and body.
Apparently she and her husband had been drinking heavily for days and were quite drunk. They had a fight after which she left the house and locked herself in the garage. He had heard a gunshot and went out to investigate. He found her on the floor and picked her up putting her in his truck, taking her to the nearest health centre. Having no ER available for a case such as this, air ambulance was called to take her to our hospital as she required care as soon as possible.
As they raced toward the road ambulance, a quick report was given to the nurse. This lady had attempted suicide, not once, but three times. She had shot herself in the stomach (missing vital organs), slit her wrists with a linoleum knife (missing her arteries), and tried to hang herself (the rope broke).
CPR was continued until they reached the hospital. Her heart was now beating and an airway was placed down her throat so that oxygen could be delivered to her. IVs were started to replace fluid loss. Her wrists were cleansed of the blood and bandage was applied to stop the bleeding while the rest of her wounds were inspected. Her neck had some small rope burns, no real injury. The bullet hole in her stomach was manipulated to retrieve the bullet and quickly sutured to prevent her intestine from passing through the hole. She was cross-matched and a blood infusion was started.
Once she became stable, suturing was started on her wrists and stomach.
She remained with us for about two weeks, after which she was transferred to a regional hospital where she began a long psychiatric program. Over time, she had quit drinking and she and her husband continue to do well. They remain in their cabin in the woods.
He could fly
Late one night, the night staff heard a bone-chilling scream. It certainly wasn't coming from inside the building as the few patients we had were all sleeping. The nurse ran to the front door and looked out the window seeing no one. The screaming continued.
For safety reasons, she called the police who arrived and found where the scream was coming from. They carried in a 16-year old boy whose feet were dangling at odd angles near his knees.
Apparently, high on drugs, he thought he could fly and climbed half way up the water tower to do just that. This tower was situated next to the hospital.
His injuries consisted of his tibia and fibula(shin) being crushed as well as his heels. He also suffered displaced vertebrae in his back. We knew that we were not equipped to handle this type of emergency, so he was medicated and stabilized and taken by air ambulance to the regional hospital.
This young man eventually had both legs removed and lives in a back brace. He has also quit drugs.
Driving through the forest up north, there are signs that read "moose - next 25 km." These signs are there for a reason as these massive animals can and do stop any traffic when they stand in the middle of the road.
We had a call from the ambulance one night that they were bringing in a man who had hit a moose with his car on the highway just out of town. There was no reason to call in back up staff, as this man was arriving DOA(dead on arrival).
The moose had gone head first through the windshield and his huge rack had decapitated the man. His head was hanging onto his body by his spinal column.
When he arrived, we moved him into our morgue and called the coroner. The coroner had to be called for any deaths arriving at the hospital.
Needless to say, the moose also met his maker as his neck was broken in the accident.
They say hitting a moose is like hitting a brick wall and this was clearly evident with this accident.
The day had started out quiet. Staff decided they would re-organize the supply room. As they were stacking and labeling various items, they heard someone hollering "help, help."
As they went running out to the desk, they saw this long-haired, dirty looking man wearing a hard hat standing at the desk. He was holding the end of his arm that had a blood soaked towel wrapped around it. Blood was running all over him and making pools on our floor.
The man said he wasn't in pain but was getting dizzy. The nurse grabbed a wheelchair and took him to the ER.
Removing the blood soaked towel, she could see the hand was gone. Blood was gushing out so a tourniquet was applied with a blood pressure cuff. This slowed the bleeding down. We asked where his hand was and he replied, "in the box of my truck."
Apparently he was working in the bush cutting down trees with a chain saw, and his hand got in the way.
One of the nurses then grabbed a bag of ice and went running to the truck to retrieve the hand. She placed the hand in the bag and brought it into the ER. We called the air ambulance to take him to the regional hospital.
We later learned the hand could not be reattached as there had been too much time between the accident and arrival at the hospital.
This man eventually returned to logging - as a truck driver.
Babies and more babies
Sometimes giving birth can be traumatic for the man of the household.
We had one lady arrive at our ER ready to give birth to twins. We immediately took her to the delivery room as birth was imminent. She was also a member of our hospital staff.
Her husband insisted on being present for the delivery and had stated that he had "no fear of blood and gore." He also wanted to video tape this wonderful event.
We did encourage family members to be a part of the birthing process if they were able and had agreed to let him in the delivery room.
Everything was going quite smoothly as she was very close to delivery of the first baby. As the babys head was on its way out of the birth canal, he took his video camera and went to the foot of the bed to stand behind the doctor.
He was standing there and no one was paying much attention to him as we were all focusing on the mom to be.
All of a sudden we heard a loud thud and lo and behold, dad was on the floor, unconscious. One of the staff grabbed the video camera and took pictures of him before checking for any damage. He did not hurt himself as he had just passed out momentarily. When he awoke, he made a beeline for the door. Needless to say, he did not witness the birth of either child.
These births were video taped by a staff member as mom wanted this done. She delivered two little babies who were very healthy.
A few weeks after the birth, we were all invited to their home to watch a "movie." It was priceless to see the opening frames of her husband on the floor prior to the birth. He never did forgive us.
Working in an emergency department in an isolated part of the country is not for everyone. You must be able to go from quiet mode to the adrenaline rush at an instant. The blood and guts can also be overwhelming. Sometimes it is you and you alone that must make a life saving decision.
This small hospital closed down when our government made changes in our province. It was converted to a health center and nursing home. No more would the ER run on adrenalin.