31 yo. Fly in Doctor, Northern Medical Unit

I woke up to day remembering the incredible nurses I worked up north with.  I’d mostly be at Island Lake, Wassagamach, and St. Theresa Point but I’d fly to all the other nursing stations in the north and plus the stints in Churchill.  As a Community Medicine Resident/Country Family Physician I did the rounds and then as Psychiatric and Community Medicine Resident and Country Family Physician I did more week to two week flights into isolated communities.  While I’d be in Shamatua as a psychiatric resident looking at the horrendous effects of glue and gas sniffing on the children I’d also do the suturing of a major laceration. 

That’s why the blond nurse first comes to mind. She was competent, down to earth, wise and just so much fun to work with. We’d had this Australian girl come in and right off she’d announced she was a feminist. She went on about how men were no longer necessary, that they’d only been useful for their brute strength but now that there were machines they’d all be replaced with women.  She was really vulgar and offensive as so many self designated feminists turned out to be.

While the blond argued we were still useful and she even made me blush saying, “a prick’s still a very nice thing even if it comes attached to a man.”  Nurses were not so much crude as not being contained by the social predjudices and frailties. I was married and often enjoyed looking at my wedding ring remembering my beautiful wife as over the years there’d be various come ons by nurses. They mainly hooked up with the pilots who were a cavalier wild competent bunch. Many a love story between pilot and nurse had a steamy start in the north.  

The feminist hadn’t just finished her baiting and put downs, making herself taller by cutting off the heads of others, when we had a call saying a drunken native man was coming with an axe.  I went to the door when he arrived and with the blond nurse disarmed him and sutured the tendons of his foot that he’d severed with the axe. It was delicate work but with the blond’s help we did a really good job.  The Australian had made herself very scarce at the first notice of a man with an axe coming. She’d actually not wanted to admit him and been on the verge of hysteria when her blond partner said, “we must open the door because that’s our job. He’ll only chop through if we ignore him.”  The chief had told us he’d chopped through a number of doors already.  The black haired young academic Aussie disappeared.  The blond stood by me and I opened the door and I convinced him that he needed me to fix his foot eventually she got him to let go of axe while lying on the table as I was about to put in some Culo wine not totally sure I liked to be doing this to a drunk clutching an axe to his chest. She was very helpful I thought and incredible competent and had a lovely way with her around difficult situations.

We’d finish up and he’d want to be on his way so we let him go with his foot in a cast. She returned the axe as he went out the door and the other nurse appeared.

She gave the Aussie a dirty look and said, “I think a man can be very helpful? Wouldn’t you agree.”  

Well she mumbled and made some excuse about not feeling well and went to bed.

The blonde nurse thanked me and said, “She’s really not so bad.  Without all the attitude.  Not too courageous as you saw but you have to give it to anyone willing to come up here. I don’t care what a person’s gender is or whatever if they’re willing to lend a hand. Thank you Doctor for doing that tonight.” 

She was one of the funniest nurses who said that she had worked so hard with so many people that her favourite thing was a moment to enjoy a good long pee.  She’d come out with these non sequiturs too and have us all laughing. The men and women natives loved her. Last I heard she’d headed further north to work with the Inuit in the most distant nursing station on one of the islands. I expected she’d link up with the delightful woman doctor I’d worked with in Churchill.

The Lesbian Ladies were the best.  A couple of old Brits who’d spent 20 years in the north. Lived like any old married couple and sounded like them together. One had arthritis and the other was so solicitous.  She knew everyone on the reserve, knew Jack Hildes like a brother. Told great stories and made marvelous soup.  I’d so enjoy my time with them and get together with them back in Winnipeg when they flew down. There were several Lesbian nurses in the north who found they could make a place for themselves outside the southern predjudices. They certainly were welcome and appreciated.

I remember the Mensa. Told us she was when she arrived. A stunningly tall beautiful black hair woman who’d come to the north for ‘experience’.  

“It’s all very well to know everything, “ she said but it’s another to have done things. “I’ve read books on delivering babies and obstetrics and I tend to remember whatever I read, photographic memory or something but I’ve never actually delivered a baby.”

At that moment I saw a woman 9 months and suggested she accompany her to the main terminal to be flown south by jet. Our policy was to fly out a lot of our deliveries because of the eclampsia, diabetes and the babies were high risk. We had no real facilities.   The ladies expecting to be flown out would avoid seeing the doctor till the last moment some times. Others wanted to fly out early in the pregnancy loving the city. This one having a half dozen children already didn’t want to leave.  

The Mensa boarded the little Cezna bush plane with the very pregnant native. The pilot notified us the take off had started labour. She delivered a healthy baby before the plane set down a half hour away at the main airport. Mother and child were well but our Mensa returned in ‘shell shock’. 

“There was no room. “ she said and we laughed at her marvellous tale of her and the mother pretzeling in the plane doing contortions to get her legs apart and the pilot having to push a foot out of his face, and eventually the woman getting comfortable enough in the awkward space that she could  deliver her  baby baby with the nurse  reaching over the seat.  Our Mensa got her wish and would deliver a couple of more babies within the month as well as have a whole lot more experience.

There was a rec centre on the reserve and the nurses would play volleyball and basketball with the teen ayers mostly.  They were always trying to get the people to execute in winter, organizing hikes and cross country skiing, participating at all levels with the community when they could.

We loved the old French priest who’d lived his whole live in the north with four nuns who worked with him in the church and the community.  The blond e nurse and he had a special arrangement. “She makes me laugh. She’s an angel.” He’d said in his thick French accent. A major documentary had been done about him by CBC French tv.  

We’d have town hall meetings. Often when Jack HIldes came to a village everyone wanted to meet him and talk to him. We had these government expeditions in spring. A half dozen officials would come up and go fishing. They’d not do much and the visits seemed mostly as a fishing trip. The natives didn’t like these people as they liked Jack who was guaranteed to do what he said he would do. He didn’t make glib promises like the politicians and then never come through. If Jack said he’d do something for a reserve then he’d do it.  

There was such a difference between the ‘wet’ reserves and the ‘dry’ reserves.  One was like hell on earth and Peyton place all mixed together while the other was like little house on the prairie. I’d notice the difference especially because repeatedly I’d survive near death experiences on the wet reserves while the dry reserves were like any middle class suburb practice.  The public health nurses, sometimes native, sometimes not were the ones that would get me to come out to the wet reserves and on one occasion tackle a drunk trying to ‘kill the white man’.

Where the kids were gas sniffing it was like being in the zombie apocalypse.

All of this contributed to me wanting to do psychiatry.  I was interested in the non compliance issue and saw that 90% of the problems in a community were due to alcohol and drugs. I’d see too that so much of medicine was tied in with secondary gain, malingering and what would come to be called factitious disorders. I wanted to help and the schizophrenics were always least cared for. I’d treat this scared men and women afraid for no apparent reason living in this other world that they’ run to. Some would head inside and others would kind of live beside themselves looking at you always from an angle. I’d say in those days that I’d go in looking for them and sometimes bring them back out with me when I returned from going down the rabbit hole. People thought I was good with this because I was crazier than most.  I’d love to ‘meet’ these people who’d ‘dropped out’.  So many turned out to be genius’s or sensitives. I loved Drama of the Gifted Child by Miller. It really captured the spirit of what I saw.

I wanted to work as a missionary doctor in Africa. I was still meditating. But it seemed like the really needy were in the north as Dr. Hildes had said and in the city it was the psychiatric patients who were the lost children of Africa in America.  

I might well have continued in Community Medicine but I couldn’t tolerate the number of committee meetings and sitting with government officials who loved to do nothing, get paid for it, and be able to show in their calendar they were in all these committee meetings where nothing got done.  I liked the hands on and seeing people and getting things done. I lacked the patience for Community Medicine but in Psychiatry I was impressed by Dr. Nady el Guebaly who was using all the advanced medical training in community medicine and public health and applying it to problems of psychiatry. I loved his work with addiction.

Also I was impressed with the analysts in their understanding the fundamental aspects of ‘resistance’. They really were addressing St. Paul’s question of ‘why do I do that which I don’t do and don’t do that which I would do?”  I had 6 months under Dr. John White’s tutelage. He was the greatest Christian psychiatrist of the day and would constantly answer my questions, “they are spiritual questions. They’re not psychiatric questions.  The problem isn’t with the brain. It’s with the will and with the relationship with God.”

Dr. Prosen was the head and a very human man who was so inspiring. 

I remember the first meeting. When the surgeons interviewed me for surgery they’d only been interested in my hands but when the psychiatrists one after another did lengthy interviews and then three together it was all about my mental health. I was thoroughly grilled and all my references were asked really personal questions. I was totally honest.

The joke at the time was that even if they could get a psychiatrist with no mental illness the job was going to drive them crazy whereas with the psychiatric nurses they only came to psychiatry because they were crazy and then working intimately with patients became same by some weird alcheminical process.

i was deemed very sane at the time I entered psychiatry. I passed all the tests and everything I’d done to date was considered well within the normal of my medical cohort. It was to change in psychiatry.  Psychiatry was like life in over drive. I was rocketed into a fourth dimension and could never return.  Everything I thought I knew in the rational one dimension world was about to be blown out of it’s socks in the encounter with the unconscious.

Freud was a genius. The Age of Rationalism had it’s limitations.  Emotionalism was no better but understanding the ‘unconscious’ was the discovery of a vast new world. I’d most enjoy the work of the hypnotist psychiatrist Dr. Milton Erickson. I’d be really moved by the learning ‘systems theory’ , working with Virginia Satir on relationships and meeting the great family therapists of the day and understanding how the identified patient was usually the ‘victim’ not the cause of the disorder.  Just as community medicine taught me how great social realities impacted on illness now I saw the family and personal history. I’d eventually become fascinated by the effects of ‘trauma’ on individual. But given my medical background I was inordinately interested in neurochemistry. A lot of my colleagues were mostly interested in becoming ‘psychotherapists’. I was too even to the point of beginning a psychoanalystic program but I was never away from the ‘brain’. I saw psychiatry as dealing with the mind. I saw the mind being ‘ biological (the brain), psychological (history of relationships) and sociologically( community and family) and eventually spiritual as Dr. White taught.  

It’s was always three and four dimensional and it’s was something I didnt need the government or hospital to do it in.  I didn’t want to deal with the institutions and all their insaneity because my work with the government had taught me that the asylum wasn’t only behind locked bars.

We’d get months of bananas and be refused amoxicillin when I was in the north. Then the arguments with some central agencies would occur and they would insist that amoxicillin was sent not bananas but we’d be sitting with hundreds of bananas and everyone would be cooking everything they could think of that inolved bananas so they wouldn’t go to waste. Meanwhile we’d have to fly a kid with otitis media out because we’d not got antibiotics time and again. 

My job in the north had been to save the government money. There had been two great family physicians who flew about the reserves doing really good work. The bureaucrats got involved and wanted to get rid of doctors.  So they set up a nurse practitioner training program with Edmonton sending a group of northern nurse to that fabulous nurse practitioner training program where the nurses did clinical rounds with the medical students. I worked with one of these originals and learned the sordid government tale.  The bureaucrats had been authoritarian and abusive so the doctors who had been going north because they like the people, fishing and wilderness, decided not to resign their contracts because the government had now set up this divide and conquer ‘parlallel nurse practioner service’. The nurse practitioners would only answer to the ‘administrator’.  That worked for a year because the administrators wanted to take all the money and deny the reserves and nurses services. Overnight after a year on the reserve to fulfill their contracts they flew down to the states where they worked with the doctors and had respect and didn’t have to deal with these communist overlords.

When people ask about ‘socialist medicine’ I always tell them to look at Indian Affairs. India Affairs was a socialist model. The rest of Canada was a mixed model of public and private health care. The epidemiology of the rest of Canada was the best in the world. The stats from the Indian Rserves under the socialist model were abysmal.

After the nurse practitioners had all left but this one who said.”I just like the north and the people too much to leave”.  The bureaucrats kept the ‘name’ ‘nurse practitioner’ and said they had two ‘nurse practitioner’s’ on every reserve but in most places they had an ‘RN” and sometimes an “LPN’ fresh out of school.  

What occured was that rather than let the natives die and continue to get poor government medical care those lovely nurses not knowing what they were doing simply medi vacced by jet all those sick people they didn’t know how to care for . A year later the government had save a hundred thousand dollars by not having doctors but acquired a ten million dollar jet medivac cost because the nurses didn’t know but cared.  

My job was to teach the nurses what they needed to know, have a communication service where they could call when they were having difficulties, hence my 24/7 day a week radio phone call service long before cellular and to teach them when to use medivac. I had this skill of knowing how long a person was likely to live and an uncanny ability (pattern recognition) to see when a person was likely to die.  

A year after being in the north I’d saved the government about 8 million dollars in medi vac fees and that would just keep on going. Jack was pleased and the nurses were all quick studies with one exception.  

I’d continue to fly up as a psychiatrist until the head of child psychiatry said I had to choose either a full time residency with him or not be in his service. I’d only learn about sociopaths and narcissists later . Jack Hildes and French were great at accommodating psychiatry as was Dr. Prosen and Dr. Bebchuck and Dr White but this guy was a narcissist and wanted 100 % undividied attention. Ironically he’d go onto do community medicine himself because he was so impressed with all the policy and epidemiology I knew and my tendency to see problems through the community medicine lense. He’d been solely trained psychoanalytically till then and only thought of the individual as a linear history model. I just made connections routinely that others didn’t see and it was thanks to Dr. Hildes influence the country doctor model and my interest in non compliance. I wish too I’d listened more to Dr. White. I wouldn’t understand what he meant when he said that the solution to the problem was spiritual. It would take a pragmatist like Dr. Gutowski to keep it simple and say ‘we have to pray about it Bill. The answere will come after we pray about it.”  When I began putting that into practice I’d see the genius of Dr. White come into play but I’d have to practice it before I could see it.  

What I was learning in psychiatry, what Dr. Prober taught me, and Dr. Falconer was really ‘space age’ at the time., so far ahead of the standard thinking. I’d do 6 months of advanced Cognitive Behavioural Therapy with the psychologist who’d trained with Dr. Beck who developed the model. I’d have exposure to the amazing works of Whitaker and Rogers and see so many absolute miracles. I’d also study psychopharmacology and see how anti psychotics worked profoundly.

“I like Haldol, doctor. Before Haldol the devil talked to me and raped me all the time. Now I can have a normal life. It’s like the television went off when I took the haldol. It saved my life.”  

I’m still amazed at what I learned in psychiatry and the brilliance of my teachers. It was beyond anything I ever imagined, intellectually, emotionally, and spiritually.  I’m still learning and intrigued and thankful to be able to help some of the people who may as well be in Africa. I’m so often working in the wilderness. The field is still in it’s infancy.  I’m so thankful to have met men like Dr. Phillip Ney and had all that other joy of seeing Ct Scans, MRI’s and Pet Scans so that Dr. Hurwitz’s neuropsychiatry and dr. Bob Stowe and Dr. Brenda Kosakas’ insights into the brain and behaviour have been so profound. It still thrills me to learn in this field especially in addiction where the question of non compliance is central and St. Paul’s words ‘why do I do that which I don’t want to do and don’t do that which I want to do’ are ever uppermost.

Unfortunately the government is lead by low brow addicts and it doesn’t matter what genius is working in the field electricity flow is limited by the slowest conductor.  I’m daily frustrated by the tragedies of this time but thankfully continue to have mentors who help me to see the laughter in the insaneity on a grand scale.