Emergency Room

Five days into my Canadian worklife I had my first shift in the ER of St. Mary's Hospital in Sechelt. Used to an enormous accident and emergency department in London with the usual big city problems - drunks, heart disease, rather inappropriate objects in various orifices and even the aftermath of bombings - nothing could prepare me for my first morning in my new ER. 

As the only doctor in the department I was responsible for everything - from sore throats to cardiac arrests - there was no handy colleague to ask advice, no superspecialists who could take responsibility for various organ issues and difficult transport issues to Vancouver. There was a freshman fear I had not felt for some time - images of my first drip, my first appendicectomy and my surgical vivas sprang to mind and the knot in my stomach took a while to dissipate.

One of my early patients was an equable elderly man with leathery skin and his hand wrapped in what appeared to be an old tea towel (dishcloth for those in the US...). 

"Hey Doc" he smiled affably.

"Hello Mr S. What seems to be the problem?"

"Aaawh, just a case of the old butterfingers while I was doing a little bit around the house, eh?" (I don't want to myth-bust the Canadian myth-busters, but there are still a few souls on the Coast who do say 'eh' with reasonable frequency). 

"May I have a look?"

He gingerly unwrapped his hand to reveal his index finger practically hanging off and a jagged wound into his palm. He smiled again.

"Is it salvageable, eh? I don't have that many left!!"

I noticed that he had fingers on both hands which were various lengths. 

"I was a circular saw operator in my day," he grinned again. It turns out missing fingers are a pretty common thing on the coast - with a paper mill, forestry and Gilligan's pub it seems inevitable.

"Ah, I see. And this injury?"

"Just a little chainsaw accident".

The only time I have ever seen a chainsaw is in an 80's slasher movie and I gulped slightly. After a little local anaesthetic and about 25 stitches later, his hand still looked a little like something from Dawn of the Dead. 

"Thanks Doc, back to work then, eh" he jumped off the bed after a quick tetanus shot and ambled out of the ER.

I was faring no better later. A woman came in with a worried frown.

"I have a tick on my leg". A what?"I have been told that a doctor should take it out so it can be tested".

I peered closely to see a body and wriggling legs protruding from the skin of her shin, rather like a little fat child with his head stuck in a the toilet bowl. 

"Just one moment" I quickly whispered to the excellent male nurse on call with me,"um, what does one do with a tick? Can I just pull it out?"

"Oooh, no. You will leave the head in and then it will be impossible to remove and will get infected. The tick also has to be alive to test for Lyme disease." Ah, Lyme disease. I read a leaflet about that when visiting the Redwood forests of Northern California and was convinced I had it after seeing a small red bite on my arm much to Craig's chagrin, "you have to take tweezers and gently extract it so no more bacteria gets into the bite". After another first I was left with a live insect in a pot with holes pierced in the lid and a piece of damp cotton wool - the lab tech took the sample with nary an utterance, suggesting it was a common occurrence. 

Rural doc had begun and I half expected a live pig or bunch of carrots as a thank you, but actually received a polite thank you note from the man with no fingers and a simple hug from the lady who did not in the end have to worry about Lyme disease. My initiation was complete for now, but that's not to say there were not surprises in store.

Sechelt and a kick in the guts

"Have you ever thought about British Columbia?". "Huh?" I was pretending to do some paperwork in the living room, but was actually watching Hollyoaks and worrying about Chester's teen population. "British Columbia? In Canada?". My husband had been perusing the British Medical Journal Careers section (which I must confess, I often used to keep the table from wobbling) and had seen one of those appealing advertisements in the back "Are you fed up with your life? Do you need more excitement? Skiing and sailing?". They are the medical version of the wonder diet pills and cheap pashminas in the back of the Sunday paper mags.

"Not really" I replied, still wondering if Justin was going to get into more trouble and feeding my secret addiction, "I've never been there, but Seattle is nice, if a little rainy". I looked at the advertisement and it did seem appealing. To be perfectly honest (and I apologise to the Canadians reading the blog for I now know better), I had always seen Canada as 'a big boring version of America' having only seen the incredibly clean Toronto and the oddly Cana-French Montreal.

Healthmatch BC, a non-profit organisation, were holding a meeting in an obscure hotel off Regent's Park for doctors who were thinking about making the big step. In a small basement conference room a few hopefuls gathered, mostly ethnic minority doctors and a couple of elderly GP's, to watch the presentation. We were treated to a film of the epic scenery of BC, from the rockies to the ocean, interspersed with very positive interviews from docs who had made the move and had gone from being exhausted couch potatoes to extreme snowboarders and intrepid waterskiers. Our interest was piqued - it had been too long that I had been arriving home after 12 hour days and watching reality tv about people making the move to Australia and Spain.

As the idea percolated I got fatter and fatter (not just the chocolate creme frappucinos, but Fraser taking shape), we researched the internet for positions available and kept in touch with Healthmatch. Where did we want to be if we did go? Whistler where you can ski pretty much year round? In the Okanagan Valley, where the vine is king and the summers hot and dry? Or on Vancouver Island with its wilderness and whale-watching? The option to work in the city was not there according to the terms of the labour market, but we were ready to leave the city (somewhat propped up by visions of River Cottage and our own veggie patch) so this was not a worry.

We quite literally chose Sechelt from Google Earth - all the water and near enough to Vancouver to go when we needed the city fix. I was 22 weeks pregnant when we arrived in our future hometown and was beginning to worry that I hadn't yet heard from Fraser. We tucked ourselves into a little cottage in the grounds of the B&B and stood in wonder on the deck overlooking the Georgia Straits. Craig immediately jumped in the big hot-tub while I dangled my feet in the water (no boiling water for the big fat woman) and watched the sun fall over Vancouver Island beyond. The next morning I woke up with a start at 7am and felt a man kicking me, and it was not my husband for once. This was the clincher - there were all the job interviews where I was taken to the coffee shop and where my high heels were looked at in wonder, and the lady who accosted us in the street and wondered if we were new in town and the blue skies and delicious ice cream, but Fraser was pretty much the sign I needed.

Then there were hoops and hurdles, a paper trail and money crossing hands (and unfortunately a very sick Mommy and a big operation), as well as tearful farewells to our families and a fond au revoir to my home and my city of 27 years, London town.

So here we are - and the lady who came up to us to chat is now my patient and the coffee shop is next to my practice. But my high heels are pretty much in retirement.

Misnomer of the Sunshine Coast

I have been asked to clarify details of where in the world we are located - our little piece of Paradise is called Sechelt and the exciting details of the town are of course on Wikipedia - http://en.wikipedia.org/wiki/Sechelt%2C_British_Columbia . Suffice to say, it's not big (3 main streets) and it's not 'happening' (unless you count drunk Canucks fans at the Lighthouse Pub) and most of the residents are indeed well over the age of consent (for a quick sherry over bridge at the Senior Centre). However, it does lie on an isthmus of land sandwiched between the Georgia Straits, with a view over to Vancouver Island, and the Sechelt Inlet - also the sea on its way round from Powell River further north. Our current house, which we are renting for now while we peruse the area, overlooks the Inlet and the beach of the Porpoise Bay (yes, really, despite the obvious lack of porpoises) Provincial Park. The view with breakfast is a definite improvement over watching the Israeli lady below have a cigarette and the meditative peace is the clear winner over endless Russian disco music from the flat above where the inmate kept rather odd hours and rather odd company. For this, we sacrifice late takeaways, corner shops open all hours and movies the week they come out.

Sechelt is home to the Shishalh (say it quickly and it becomes apparent how the town was named by the European settlers) First Nation who have a reserve in the town - funnily enough where both Starbucks and the Hospital sit, among other shops and restaurants. Many of the orginal First Nation population were wiped out by diseases such as smallpox brought by the settlers. Unfortunately they are now being wiped out by drugs, violence and alcohol more often than they should be, having gone through a horrendous residential program akin to that of the indigenous population in Australia, which left a post-traumatic stress disorder that was hard to fix with apologies. More on some of the remaining traditions in a later post.

We sit between Gibsons/Langdale where the ferry from Vancouver runs back and forth at the whim of BC Ferries and Halfmoon Bay/Pender Harbor to the north where another ferry heads 'upcoast' to Powell River. The Sunshine Coast was apparently named by some braniac in Roberts Creek who had obviously lived in Vancouver way too long and realised we have minimally less rainfall per year. And this is where the tourist industry began.....Although as we are constantly being told, there are 5 more 'growing days' per year here than in Hawaii (along with 'we never get snow', a myth that was quickly dispelled this year).

More on the various communities in later posts and it actually was sunny today.

Strange Situations

Working in London in the NHS I would rarely see patients outside work. One memorable summer evening we chose to eat outside at an Italian restaurant local to my practice. A veritable stream of patients passed the table with a nod and a wink, but no-one approached me with chatter or problems. How different life is in a smalltown. In the summer, not long after we arrived, it would take me at least an hour to walk round 16 stalls at the Farmer's Market in Sechelt. Now I find myself unable to go anywhere without seeing a patient. This week I was at the pool and in the awkward position of trying to change in the open women's changing room. Although patients are usually comfortable removing clothes for examinations, how comfortable would they be seeing me in all my glory. A similar situation arose at the cinema - I go through boxes of tissues weekly in my office listening to stories happy and sad, but would the patient mind seeing me with a red nose and swollen eyes, proving that indeed, doctors are human....I daren't even contemplate having one too many in the Lighthouse Pub.....

Building a new life in Western Canada

Have finally decided to give this blogging thing a try - it will only be interesting in any way to those who know us, and maybe not even to them.

As we start our life in Canada and cope with bears, ferries, people saying 'eh' and too many pine trees, we hope you will join us in our journey.....