Monday, May 11, 2015

Happy Nurses Week

My initial four month contract is now up and I am home for a few weeks.  It's been five days and I'm still a little disoriented.  I was warned that coming home is often hard and they weren't kidding...  And why wouldn't it be? I've gone from temperatures of -5°C (and dry) to 30°C (and very humid) overnight.  The occasional call of a raven, a dog barking or the alien sound of Skidoos tearing around town late at night have been replaced by sirens, children, songbirds, televisions and (what seems like incessantly ringing) telephones.  It doesn't help either that my house faces a major intersection in a city of over half a million people. I forgot about the constant rumble and occasional honking/screeching/shouting and crashing that takes place.  Everything smells weird too.  As I type this, I've decided that I'm finally comfortable; wearing my tank top and capris I have parked myself next to the vent in the kitchen.  The quiet hum of the air conditioning and the fan on the range hood are managing to drown out most of the noise... save one robin who is very adamantly calling for rain.  He can stay for now.  If it gets too much, I may have to resort to my ear phones, like I have many times before.

My journey home was an adventure into itself, one that has carved a big chunk of time away from my family and friends.  However, that is a story for another day.  Today is the start of Nurses Week, and now that I am in a totally new position in a totally new area, I find myself drawn to talking about that instead.

Unlike here, "in the south" (as we say), RN's and RPN's (Registered Psychiatric Nurses) have a very much expanded scope of practice.  We have to: there are no regular doctors where we are and even in the most dire of emergencies, a patient has to be medivaced to Iqaluit which is over an hour away (and weather permitting).  The Community Health Nurses (CHN, or "chins") are primary practitioners;  they do everything from full assessments, to paps to giving antibiotics to dispense medication to casting to stitches and beyond.  In my world, the world of Mental Health, my job description of CPN (Community Psychiatric Nurse) does the job of many departments and agencies down here.  Myself, I am in charge of:
  • the distribution of medication for <30 chronic patients (both "injection clinic" and blister packs)
  • dispensing of PRNs and hold over medications from pharmacy.
  • the case management of >10 patients in "out of territory" placement (which currently includes 4 other provinces)
  • the case management of >5 "in community placement" clients
  • crisis intervention
  • liaising with police, social work, income support, housing and other government bodies
  • individual and group counseling for clients in a chronically suicidal community
  • psychosocial and psychiatric assessments
 ...and then some.  It's hard being the only skull jockey in town... you get called at all hours to do the damndest things.

The putting of this here is not so much "hey, dig me!" as it is with the intention of illustrating the impact that one nurse can make.  I'm especially eager to share my new findings as up until recently, I was pretty disillusioned and hopeless with my profession, especially in Ontario.  I will admit too, there were times in the never ending night of Nunavut when I asked myself what the hell I was doing here (and where exactly was that again)?  What possible difference could I make to a community that has experienced more pain, more trauma, more violence than I can ever try and explain, never mind try and change?  I'd have better luck holding back a glacier.

Well, here are some answers.  I've removed exact numbers for the sake of privacy, but know they are not an exaggeration.  One Community Psychiatric Nurse, in four months:
  • saw almost as many clients as my last unit saw in a year (documented)
  • prevented many suicides (documented)
  • reunited several families and offered/gave healing
  • helped people in need
  • revamped the metabolic monitoring program for the community (and other programs)
  • oversaw the medication for chronically ill clients
  • taught medication, illness, coping strategies, sleep hygiene, thought changing and mindfulness countless times
  • advocated constantly for the mentally ill with the public, governing bodies, police, social work, medical staff and families.
  • attended review board hearings, Community planning meetings and been a stakeholder in direct community funding from the federal government
  • fed the hungry
  • tended to the biopsychosocial needs of the community, the agencies working within the community and the employees of the health centre (nurses included).
  • got three very treatment resistive clients back on medication
  • fought for, and got, increased funding for the Tuesday lunch program for chronic psychiatric clients (and increased caloric and nutritional intake therein)
  • helped ensure there were no new cases of syphilis for 2 months (documented)
  • assisted with cases all over Baffin Island in territorial rounds

And there are 13 of us, one in each community in Qikiqtaaluk.

To be fair, I, and my colleagues, do get paid well for our work.  However, I did get more out of it than simple monetary reimbursement.  In my last four months, as a nurse in Nunavut, I also got to:

  • meet some awesome people
  • find purpose
  • learned to draw
  • did some very important healing
  • learned much about the Inuit, their culture, their past and vision for the future
  • learned to cook and eat healthy in a climate that is definitely not supportive of this
  • renewed my faith in myself
  • renewed my faith in my calling
  • renewed my love of art including photography
  • seen beauty so breathtaking, I cried 

I don't know many other professions where that would happen.  I don't know many nurses that could say that either.

I have spent my entire career believing nursing to be one thing.  It was only after leaving my home province and going north that I found it to be much more;  to be more holistic and rewarding and generally much more like what I had envisioned as I was starting out.

I was told by a seasoned traveling nurse (about a month after I arrived) that "...only in this profession can you do what we do, go where we go, help who we can. We can make this job our own.  As a nurse in Canada, you can travel the world... and globally you can give people care and healing.  Be proud that you are a nurse.  For you already have and will continue to see and do things that no one else ever will..."

I can't argue with that.

I've been asked countless times in the last month "Are you coming/going back?"

Of course I am.

I'd be silly not to, wouldn't I?

Happy Nurses Week, wherever and however you practice.  Know that you do make a difference... and that no other calling can compare.

Saturday, March 28, 2015

A Thousand Stitches, The Rhythm and The Dancing Bear

On Fridays, the hallway outside of my office turns into a mobile Art Gallery.

It used to be every day;  there would be a knock at the door and you'd look up from your charting to see someone pulling something handcrafted out of their pocket, hoping you would buy.  It got to be a bit much, between the interruptions of work, the badgering and haranguing that often took place,  and the constant knocking at your door in the evening.  Our NIC instituted a "only Friday afternoon" rule, which is slowly being enforced. I guess the word is out as well, because two weeks ago there was quite a procession.  I had to miss last Friday due to my sciatica issues, but this Friday brought out a few carvers, some knitters and a beader.

Small Dancing Bear
In my time here, I've seen carvings large and small, precariously balanced on the narrow ledge of the Dutch door of the front office.  There are common themes here and it is always cool to see so-and-so's interpretation of a specific topic.  Dancing animals are prevalent, those representations of the moment the shaman takes on the animal characteristics of the tuurngait spirit that he or she summons from drum dancing.  I've seen dancing bears of course, musk oxen and even a few birds and an owl.  There are also multiple carvings;  lacy representations of schools of fish, narwhal, seals or other sea creatures swirling in an endless spiral.  There are also the trans-formative pieces which really interest me.  You will often see the transformation or melding of the spirits with the shaman represented with at least one human face and many animal faces together.  There are also animals walking, standing and diving.  Each has their own significance and their level of difficulty.

We cannot forget the inuksuit (singular inuksuk or "inukshuk" in English), which seem to be the most popular carving (as everyone seems to make them).  I've also seen a few intriguing female carvings come through, but sadly did not have the money at just the right time.  Carvings are crafted of marble, soapstone (both light and dark) and serpentine.  I have also seen antler and walrus tusks used as well.

Not surprising, many of my patients are very creative.  At least one of them is a very well known carver.  He is probably the most stable person in town, but he always pops in to say hi and for a bit of a chat.  Yesterday he brought out a beautiful bear that he had carved.  I loved it (lets be honest, I love all his work), but sadly I only had $80 cash on me, and the asking price was $200.  One of my faster colleagues snatched it right up, but allowed me to snap a photo of it.  I really liked this bear... he looks humble.

I still love this bear.  Next time...

These will keep baby girl's hands warm (and have a
traditional A-shaped cord to ensure she doesn't lose them).
There are other things that come through as well.  There are "typical" Dorset knitted hats with designs or words woven into them.  There are handmade mitts, such as the ones I bought for my daughter.  These are suede with rabbit trim and lined with sheepskin, but I have seen them made out of leather or fur and are most often trimmed with fox.  Tiny crocheted decorations--usually miniature representations of hats and mitts or kamiks--are common too and can be used for zipper pulls or earrings.  I have seen a few dolls perched on that ledge, as well as wall hangings, barrettes, pins and cuff bracelets made of sealskin (fur) or beaded.  There are hand carved silver earrings as well, much like the pair of boots I received as a gift.  Again, I've missed out on a lot of good stuff in the beginning, but I still have my eye out for a few good things, including a floral barrette of sealskin and fox for my daughter's hair.  And maybe one for mine too.
Handmade silver earrings I received as a gift.  :-)

From the moment that I landed in Iqualuit, I have been completely fascinated with the amauti that the women wear.  As individual, intricate, detailed and meaningful as any custom made sari, the amauti is beautiful, functional and warm.  Every day I watch the parade past my office in the clinic and marvel at the different interpretations, fabrics, beads and of course, the fur trim.  Fur is a necessity here:  without the coyote fur on my hood, my face would have frozen in the -40 temps many times... and without me knowing it.  Unlike in the GTA (where I am from), where cold is bitterly cold due to the dampness, here it is not felt the same.  Minus -40C can actually feel like -10 or so at home and what seems like a quick dash across the street without gloves can mean frostbite very quickly. 
L.'s Dorset style sealskin kamiks. Gorgeous!
The fur on a parka or amauti runs down, from top to bottom, getting the most warm air barrier as possible.  I'd be lying if I said I didn't have a peek at the babies as they go by either, snug at their mother's back.  It is a fallacy that babies ride around in the hood;  instead they are placed at a pouch like area along the mother's back, where her body heat help keeps them both warm.  The hood of an amauti is massive and meant to cover both heads. 

On the way in at the airport in Iqualuit, I saw an amauti with the hood and inside lined with actual fur and marveled at it (and was disappointed that I did not see a similar one here).  Now that I am here in Cape Dorset, I realize that the wind and weather in Iqualuit is much harsher and that fur lining may suit them better.

Almost as intriguing are the kamiks.  I was admiring my friend's one day and she told me that they had belonged to her Grandmother.   I must have asked her a zillion questions about them and she patiently answered them all.  As I've been here I've seen quite a few, and I must admit, I prefer the traditional Dorset style that she has with the sealskin and triangle designs.  From the needlework on the stocking (liner) portion, to the reported (and renown) thousand stitches across the top of the foot (attaching it to the sole), each is a work of art.

The needlework on these is just to die for... 

I'd be remiss if I didn't mention one of the other major art forms in town:  throat singing.  It is not singing as most people in the south would recognize and it is nothing like the Mongolian whistling style of throat singing.  Here, as I was discussing with a lady from the town the other day, the rhythm is not the background, the stage setter that it is in most Western (southern) musical styles.  Instead the focus is the rhythm, and everything else is simple accompaniment.  Inuktitut is like that too:  unlike English which is flowery and has many words in a sentence that add only flavour or window dressing, the native language here is straightforward and to the point.  It is function over form, yet at the same time, no less beautiful. She liked that.

Throat singing takes place completely in the throat and therefore it seems logical that the singers face each other.  What may not be apparent to the inexperienced eye is that this is a competition as well, as much as a face off as any epic guitar battle.  Our mental health program helps sponsor the local throat singing classes and I am lucky enough to have a friend and employee that has been throat singing since she was seven.  She has graciously allowed me to show her teachers performing, and then herself and her teacher.

These two amazing ladies were my throat singing instructors when I was 7... They are still able to instruct and teach up to today. Just phenomenal! #ThroatSinging
Posted by Louisa Parr Pootoogook on Tuesday, 24 February 2015

This lovely lady has been my throat singing teacher since I was 7. I am honoured I can still throat sing with her up to today and will always be thankful for her for having to take her time to teach me and others. I hope one day I will be as great as she is <3
Posted by Louisa Parr Pootoogook on Thursday, 5 March 2015

There is so much beauty and creativity around me, that I don't even know where to look sometimes.  I've finally put the money out for a new DSLR;  I cannot wait to capture more of the wonders that exist at this latitude.  Every morning I look out to the mountains and brilliant blue sky and think "look at that"--and marvel for a few moments before I get on with my day.  Even on those rare days when it is snowing and the Arctic wind snarls, I'm still in awe of the power, the ferocity of nature up here.  Jawaharlal Nehru once said that "the art of a people is a true mirror to their minds".  Since I am charged with the mental wellness of this community, it is only natural then that I explore the creativity that lives in this, the art capital of Nunavut.

Our environment shapes us, and we express this, and many other, shapings through art.  If I want to understand the expression of emotion, to hear and comfort the cries of the souls that live here, instead of consulting the DSM, or my code book, I'll have a little more luck with a thousand stitches, embracing the rhythm and the dancing bear.

Sunday, March 8, 2015

Here I Am

You know it's cold in the North, when the snow your boots kick up, skitters in front of you and sounds like a vibrating high tension wire.

In Brampton, where I am from, there are many different kinds of snow. There it ranges from slush to gingerbread to frozen solid. The temperature fluctuates constantly. As we say, if you don't like the weather, wait five minutes and it will change. It gets cold here and stays below minus 25 until May. Snow is icy here; packed by the runners of many snowmobiles and squeaking as you walk. It was skipping ahead of me, as I walked this night, with it's eerie warble echoing off the hills and the houses that I passed. Frost piled up on the surface of my parka as I went, my breath freezing into a sparkling halo around my face. I was giddy tho', full of good company, good food and laughter. I was also full of promise. Of hope. Things that I had not felt in a long time.

The last year or so has been hard for many. As I've said before, I am no exception to this. 2014 saw many changes in my world, including the sudden loss of my younger brother. My life was so full of sadness that I had to make some drastic changes. I lost 75 or so pounds, I changed my eating. Somehow I lost the ability to digest meat. Fish, thankfully, is still on the menu, but with the sudden change from a high protein diet to something else, you can imagine the shock I was in for.

So, here I am.

In this place, where winter can so easily mean death, surprisingly, I have found life. Although this community has known much hardship over the years, there is still much beauty. Cape Dorset is the art capital of Nunavut; everyone here carves or draws or sews or makes prints. It is very difficult to find someone without some kind of artistic leaning; it can also be throat singing or cooking or playing an instrument or simply writing “Electric pow wow” or rap lyrics for ones self. As the only Mental Health professional here, I encourage and tap into that undercurrent as much as I can. This town, her people, have all had a shadow touch them. With any luck, the sun slowly creeping up and over the horizon will help dispel some shadows. Then perhaps, the seeds I plant will be allowed to grow.

That night, as we crunched merrily along, I saw the northern lights for the first time. Although they were low in their cycle and a faint green stain amongst the millions of stars, they flickered up and overhead in a dancing arch. We walked behind one of the hills, where the street lights did not reach and whistled to watch them change. The other nurse and I must have been outside in -40C for over an hour. We stood transfixed at times, watching “the lights” waver across the skies as Orion the hunter stood at the ready. Realizing we were tired and soon to be frozen solid, we parted company shortly thereafter and as I walked home at night for the first time in years.  Surprisingly, I felt no fear. Only peace... and an understanding that I was very much in the presence of something much bigger than myself.

I am reminded almost daily that it was a very hard thing to leave my life, my “comfort zone” and fly thousands of miles into the tundra and attempt a job that has burned out the last three nurses that have held it. What I say to those that offer this tidbit up is, yes, you are correct. It was hard. It was also hard to watch my brother die on my birthday. It was hard to do the last job I did. The last year was hard. It's been hard all over. Instead of crawling into a bottle of Jack or drinking wine on a beach somewhere, instead I opted to go to (seemingly) the land of hard. Life is hard here and can be as cruel as the winds that blow in from the ocean. But, once the winds settle and the stillness returns, there is a vibration here that resonates deep within my soul. I can't explain it. I do know that you can see it in my face and I can feel it in my step. This place is right. This time is right. What a relief and a joy it is to finally feel that.

One of my patients told me the other day “we have waited a long time for you”. I hope she is right, and I have to admit, it was really great to hear. I hope I am able to live up to the expectations and the awesome responsibilities I have here. The pain in this town is real and almost palpable some days. As I walked into the stifling warmth of the Health Centre that night, and ran into one of my colleagues tending to a very sick baby, I thought of the reasons that had brought me to Nunavut and the reasons I had become a nurse in the first place. For the first time in a long time, I felt like I could help people again. I feel like myself again.

So, here I am.

Staring in wonder as I whistle at the stars.

Not a really bad place to be, if you really think about it.

And I fell apart, but got back up again...”
-Alibi, 30 Seconds to Mars

Saturday, March 7, 2015

Really?... WHY?

I get this question a lot.

A.  Lot.

In the defense of most (generally well meaning-type) people that say this to me, I have had a lot of changes recently.  2014 was probably the hardest and most transformative year in my life so far.  I have seen the darkness.  I came back.  I recovered from a (not so) "mystery" illness that had been plaguing me for some time.  I changed my eating.  I lost weight and changed my outer appearance somewhat.  I lost loved ones.  I felt the need to switch tracks.  I got a few more tattoos and generally, stepped way outside my comfort zone.

In the middle of it all, somewhere around July-ish, I was looking for a new job.  To say the bloom was off the rose would be a bit of an understatement.  The bloom was off, the rose was dead.  The dessicated bush was just a tangle of spines that would stick and grab at your clothing no matter how far away you thought you were from the damn thing.  It was time to go.  But where?  I was quietly cruising through listings on my phone one afternoon when I spied "Full Time Psychiatric Nurse - Nunavut".



I kept going but something nudged me to go look at it again.  There were incentives.  Bonuses.  A huge job description that suited my needs as a nurse and as a person.  No more shiftwork.  Lots of call.  Lots of money.  Everything from community care nursing and injections to crisis intervention.  Ooooooh... it was too lovely.

I fixed up my resume, and with nervousness bordering on an anxiety attack, I sent it off.

They called me in October.  By December they wanted me to come up now!  Wanting Christmas with the kids before I embarked off to places unknown, I pushed off my departure until January. 

The early morning of January 12th saw my family trundling my enormous pile of suitcases to the airport.  By that night (and after a journey that is a story into itself) I was snug in my new bed, in my new apartment, waiting for my new job to start in the morning.

Where the hell was I?  What the hell was I doing?  These questions and more ran through my head as I got a grasp on the place, on my apartment, on my job, on the people... anything and everything here is so much different than back home.  But, that is not a bad thing, as I have found out in my time here.  There is a lot of pain and problems and social issues.  There is also a lot of light, a lot of love and a lot of healing.

I've got a lot stacked against me.  I'm a hard to fit size.  I stopped eating most meat months ago as I can no longer digest them.  I'm Caucasian.  I'm an internet based creature in a place where it is joked that they have InterNOT.  I'm from GTA:  I'm used to humidity and fluctuations in temperature and getting anything I need or want from the store or delivered to my house.  I stopped cooking a few years ago.  I also have a young family of three children and a husband who is not coming with me.

Despite all that, in a handful of days, I will be Nunavummiut.

Welcome to Nunavut.  Welcome to Qikiqtaaluk (Baffin Island).  Welcome to Kinngait (Cape Dorset).

Welcome to the North.

(The snow out my front door)