I was on my way to this content after the first paragraph of the previous episode, but mentioning the ambulance entrance next to our clinic, and some exchange with the person most connected with that service, lead me to the side track that you saw there.
Continuing on then where I was headed. You probably wonder why the question. I am going to comment about the first patient I remember seeing in that clinic in Gladstone. However, the question mark with the bracketed ’s' is present because I had seen dozens if not hundreds of patients already by that time.
As medical students, we were introduced to patients in the third year if not already the second. After my second year of medicine, with some quick training by a doctor, Michael Scott, who was in charge of outreach of The Northern Medical Unit in Winnipeg, I spent the summer learning the practice of outpatient medicine in my former hometown (ages 2-10) of Grand Rapids. This is a community some 300 miles north of Winnipeg. I worked with nurse Betty Calyn, nee Hildebrand, from the town of Morden, only 7 miles from where I was born, and also of Mennonite background like myself. This was all under the eye of Dr. Steenson from Ashern, who would come up mostly on a weekly basis.
In addition to the usual situations that present themselves in outpatient clinics, having been given a crash course in suturing, there was some of that minor surgery to be done. We had also been taught the correct way of removing fishhooks, as this is a community where people from outside come to fish with rod and reel - around the village or at a lodge(s) nearby. The locals do net fishing on Lake Winnipeg and had formed their own fish co-op already. Besides helping patients from the mixed – blood and Caucasian community on the west side of the Saskatchewan River, we also served the indigenous community on the east side of the river, in what is now known as the Misipawistik Reserve. Once a week, we also traveled to Easterville/Chemawawin Reserve for a clinic there. This was sad community about 30 miles south of Winnipeg, built more or less on the limestone rocks of the ridge that traverses Manitoba from Long Point to t e east on Lake Winnipeg, westwards towards Saskatchewan. They were the members of the Cedar Lake band that had been displaced from their lovely community on the shores of Cedar Lake when Manitoba Hydro decided to use the Saskatchewan River to build a hydroelectric dam at Grand Rapids and flooded out this upstream community. Needless to say, that whole story has not yet been resolved.
Besides seeing local patients with complaints referable to every body system, be they acute or part of a chronic condition, we also did immunizations, prenatal and postnatal care. We never did have to deliver a baby. Either there were a local midwives that took care of that or they had gone out to a hospital, perhaps in The Pas or Ashern or elsewhere.
After my third year of medicine, under the auspices of the same program, I spent the summer at another nursing station under Dr. Scott's supervision, at South Indian Lake Manitoba. There was a similarity here to what was happening in the environment to what had happened at Easterville/Grand Rapids. Again, Manitoba Hydro was undergoing a major effort in diverting the Churchill River to provide more water flow for more hydroelectric dam development downstream, towards Hudson Bay. The result of this was that a year or so after I left this community, a good deal of it was also flooded out. It had been a scattered community on both sides of the river/lake, but if my memory serves me correctly, all were removed to the east side.
This community was more remote than Grand Rapids, which had highway connections to the rest of the province. South Indian Lake then was only served by regular Calm Air service to Thompson on the way south and Leaf Rapids and Lynn Lake on the way west. Thus, when we had patients that needed services beyond what we could provide locally, we either sent them out on these planes in whichever direction was most convenient, or dictated by the gravity of the illness. Thompson was a bigger center, already on the way to Winnipeg, so more severe conditions were always sent that way. Sometimes, the situation was acute enough that a charter plane was used to make an evacuation.
One aspect of medical evacuations was that they needed to be accompanied by someone with some healthcare or medical training. This was where I, as a medical student, often came in. I don't recall trips to Thompson as much as to Liynn Lake. One I remember there was a young indigenous woman who needed medical attention subsequent to a miscarriage. The physician who took care of there there was the same one who turned out to be a community colleague when I started in Gladstone, Dr. Ruth Cottrill. Once Dr. Cottrill had taken care of the patient, we still had an evening and morning before the return flight to South Indian Lake. All our expenses were paid, so the patient and I went out for dinner together, watched some TV in my room together, no doubt had breakfast the next morning together, and then flew back to South Indian Lake. I did this as a human being with another human out of their environment, although some might chastise me for crossing boundaries. I met this woman again at a residential alcohol treatment centre in Winnipeg was when I was taking a brief alcohol and drug addictions residency. That prompted me to write a song, “Marita", about her. If you are curious, you can find it under my name on Soundcloud. It might even be on my Youtube channel.
This hydroelectric intrusion into the South Indian Lake community came some 15 years later than it had come to Cedar Lake and Grand Rapids. At that time, I was not even a teenager, whereas here I was a young adult. Between that and my position, I became much more aware of local feelings about the whole situation. One young girl returned from British Columbia to see her hometown before it all changed. Her sadness reflected that of an elder in the community, Annie Moose, whose words led me to write a poem called Little Birches (on my Facebook page). She was wondering what would happen to the new growth along the lakeshore. The young woman’s reflections led me to write another song, which is also on my Soundcloud and Youtube accounts, "Anna's Song." With the capabilities of the Internet, and the help of Facebook connections in South Indian Lake, within the last decade I had made contact with Anna again, this time living on Vancouver Island.
There was a large camp of Hydro workers in the community already at this time. They had their own kitchen and cooking staff and for a price, local inhabitants could eat there as well. The downside of that was when it appeared that the cook did not perform the best hygiene and introduced Shigella into the community. That led to an outbreak which, to my recollection, no one died from. However, there were some severe cases of this gastroenteritis. I got the nickname of "shit collector" because one of my tasks was to go around the community collecting stool samples for a control and a public health project we then undertook. Needless to say, I was not always a welcome visitor. Who would be if that's what you came for, but also because my being seen visiting you might identify you as a carrier which might not be pleasant in the community.
Just the same, I enjoyed my experience here enough that when the call went out for someone to go back to this community for the Christmas and New Year break, I went. Part of the reason for this was the nurse was going on a holiday, which ended up with me having to look for a nurse to work under, as that was the stipulation in those circumstances. A friend at the time, Rosalie Loeppke, obliged me and we had a good time. It was quiet in the community as the Hydro workers had all left for the season. One of the major difficulties we had to contend with was keeping things from freezing, as we did have running water and sewer. We used snowmobile for getting around and sometimes that was difficult to start but we had a good maintenance man, Lamont Linklater.
There were two medical experiences that stand out in my mind from this short stay. One was a woman coming in labour when we were unable to arrange an evacuation. All went well though, and a healthy little boy came into the world. The other was when a woman somehow got an ugly slash down her leg from a snowmobile on which she was a passenger. We cleaned it up and I tried to suture it but realized it was more than could be handled by simply closing the gap. We covered our efforts with sterile dressing and arrange for an evacuation.
The other non-medical experience that I remember was the one time in my life, so far, although there is little chance of that happening really where I live now, of falling through the ice. Rosalie and I were out for a nice evening walk on the lake when we chanced too close to some reef rocks where the current was greater and down I went. I managed to step my way out and made a quick run for the nursing station to change into dry clothes!
We enjoyed socializing with some of the locals and the next door Hudson Bay Company staff over Christmas (the manager’s wife was a former schoolmate from Grand Rapids) and I also enjoyed being able to attend the community New Year's dance, where we were entertained via a decent rock band from Nelson House. I even got to dance with our attractive nursing station administration assistant. It was the beginning of 1975 when we left the community.
In both these summer circumstances, I enjoyed my time being back up north, where I had been raised till the age of 16. They were like homecomings. Family even came to visit me in Grand Rapids and in South Indian Lake my youngest brother spent some time with me.
Then, there was one more extended situation where I saw a patient before I was actually in my own practice seeing patients, which we will come to yet. This third situation was where, as a second year Family Practice Resident, with a license to practice, I was part of the St. Boniface Family Practice Unit Outreach Program to Northern communities. This led me to take small planes this time, to fly into Bloodvein River and Little Grand Rapids, which included extension trips into Paungassi. These communities were known to me, even though I had never been in them before, as the same mission that my parents were working under when we spent five years in the community of Loon Straits on Lake Winnipeg, had mission stations, as they were then called, at both Bloodvein and Paungassi, so I knew these “missionaries”. This work also at times included Little Grand Rapids and there were resident workers there at times too. My own parents spent a summer there in the mid ‘70s.
This situation again basically allowed for seeing outpatients on consultation with the nurses who ran the nursing station. Sometimes this also then included decision about evacuations. Again, immunizations would've been part of the program as well as prenatal care and post surgical care. All these situations, including continuing care of individuals with hypertension, diabetes, arthritis, respiratory and bowel conditions would have been part of the every day experience. Even though in the first two instances, I was a student, under the circumstances, and the supervision of the nurse and then doctor, we dispensed basic medication such as lower level antibiotics, anti-hypertensive, diabetic medication and medication for arthritis. Now, with three more years of medical education, I could make better assessments and make more advanced decisions about intervention.
Not having kept a log of these experiences, I must say I really cannot recall individual patient experiences from most of my time in these communities. Again, I enjoyed all of this, as it gave me a chance to interact with people of the north, particularly indigenous people, such as I had grown up with. There were also opportunities to do fishing, canoeing and boating; there was time for some pleasure.
So, that first real patient of mine in practice - even here I might have to declare a caveat. I was not in private practice, so patients really ‘belonged’ to the health centre.
I ushered a woman whom I judged to be in or nearing middle-age into the examining room. I offered her the chair for patients and she sat down - or should I say tried to. Without wanting to be disrespectful, the truth was her girth prevented her from sitting down comfortably between the rms of the chair, let along then easily extricate herself. We did get acquainted and I got her blood pressure checked, which is what she had come for. I don’t recall whether she had been a previous patient of the clinic or whether she was just coming to check out the new doctor. She had driven a few miles, as she was from one of the ‘seven regions’, namely the neighbouring village of Plumas. I do remember that I did not see her again. I guess she went back to whomever she had been ‘doctoring with’ before.
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