Welcome to Pangnirtung

The picture you see up there is the view of the fjord where the community of Pangnirtung is located. You can't see it because I don't know how to take timely pictures. It's just around the corner of the landmass on the right. The story of why I was able to sit between two pilots and take this shot from the front window of a very small plane is the topic of today's post. I was going to post about a hike that I took but this is way more interesting. Also, I actually have pictures to show. Because I remembered 3 days after losing my camera that my iPhone can take pictures. Because somebody reminded me. Because I'm slow.

As always, I'll start off by showing you a map because (and I hope this doesn't insult you) I assume that the majority of you are not super familiar with the geography of Nunavut. I know that I'm certainly not familiar with it enough yet to have non-embarrasing conversations. "Oh, you're from Hall Beach" I'd say. "That's not too far a plane ride I guess". Then I'm told that Hall Beach is actually not on Baffin Island at all and I'm mixing it up with Cape Dorset. But now I know where both those places are! And, more on topic, I also know where Pangnirtung is.

Pangnirtung ("Pang" for the in-crowd) is about 200 km north of Iqaluit. It's easily recognizable as the red dot on the map that is not Iqaluit. It has a population of around 1400, almost all inuit (like every community on Baffin except Iqaluit). Pang is at the entrance to Auyuittuq National Park and is also the home to an infant who put a small object in his mouth.

On the right you can see the plane I flew on to Pang. That's pretty much the entire cabin area. There's enough room for three medical personnel and there's a strecher for the patient underneath all those bags. On the top you can see an oxygen source and an IV pump and then on the bottom and at the back you can see a ton of bags. They contain pretty much all the equipment you'd think you would need in an emergency.

I was asked to accompany the regular crew (a nurse and a respiratory therapist) to pick up an infant who had put something in his mouth and had briefly obstructed his airway (bad) but then something happened and he was breathing again (good). We knew that the nurses in Pang thought that the object was still in his pharynx (below the mouth, above the trachea and esophagus) and that he was - for the time being - breathing okay. That was it. The nurse and RT were pretty amazing at their job and I was told that I only needed to accompany them "in the very unlikely case he needs a tracheostomy". Other residents should know what this means and how scary that 'unlikely case' would be. That yellow book at the bottom of the picture is my critical care handbook where I was furiously reading the same paragraph about tracheostomies over and over again as if somehow that way I could burn the skill into my muscle memory. I'll save the suspense now and say that that particular intervention was not needed, although something else was.

When we got to Pang, we got a ride straight from the airport to the health center (approximately 400 meters). It was on the ride that I realized that the nurse and RT wanted me to remove the object from the child's throat (or wherever it happened to be) before we got back on the flight. Whereas I was really hoping that somebody else (like a surgeon or something) would do it when we got back to the hospital. Of course, my colleagues were in the right. It would definitely be easier to solve the problem on the ground then to have to react to an emergency in the air. At the very least, we rationalized, we could stabilize the child by intubating him.

At this point, I should start explaining what all this means. To the left is a picture of the best possible view you could get of a throat. In case you thought that your throat is not disgusting, I hope this picture disabuses you of that notion. The large bit on the top is epiglottis and the two white strips in the middle are the vocal cords. The trachea is just beyond those cords. The goal of "intubation" is to put a tube into the trachea so that you can control what goes in and out of the airway. In our situation, this would be desirable because if you could get a tube in there, the object in the child's throat wouldn't be able to obstruct the trachea since the tube would be taking up most of the room. In that way, the airway would be "protected".

Of course, the task is much harder when the view is more like the one on the right. So this is why I had one of the biggest adrenaline rushes in my life - I wasn't sure that I could get the thing out and I thought that I might even push it down with my laryngoscope (what you use to look in the throat) and I wasn't totally confident about how easy it would be to get a tube in.

When we got there we had to get the kid sedated enough to take a look. It turns out that this child would be a really succesful heroin addict because we gave him enough of a similar drug (fentanyl) to put two infants in a very deep sleep but he was just high and happy and swinging his oxygen mask at our heads. This was very cute but not helpful. We finally got him to sleep using other drugs and then... the moment of truth...

...Which turned out to not be a big deal at all because the object (a lovely piece of jewelery) came out really easily and the child was totally well (but high) afterwards. Also, I'm overexaggerating the scariness of the situation for drama's sake because I did have a highly experienced respiratory therapist standing next to me who could have saved the day in probably any situation. But I was definitely scared out of proportion to reality and that is why it's burned in my memory and has become a super long blog post that is way less well written than I had originally hoped.

But, as may be evident, I'm really tired now and I haven't posted in a week (this actually happened last week) because it's been really busy and there's no way I'm going back to edit anything. So you're going to have to live with this. Here are some more pictures of Pang. 2 of them I took myself, one of them is an artist's rendition of the local wildlife.