Until Next Time. . .

You can't jump a jet plane,
Like you can a freight train,
So I'd best be on my way,
In the early morning rain.

-- Gordon Lightfoot, Early Morning Rain

In a few hours, I'll be leaving Yellowknife. I have a lot of photos I haven't posted, but I think I'll leave that project for another day.

I have unfinished business here still. My plans to see the aurora, to take out my star chart and gaze upwards, to drive out of town on a clear night and be alone with my own thoughts were more or less dashed by cloudy nights and full moons, although I did get a good look at Mars while I was here. Oh well. Two of those things I can do in Ontario.

I also didn't buy any gifts for friends and family back home. I really don't think my family would get much mileage out of it anyways; we aren't really "souvenir" people. I also didn't see much that I wanted to buy for any single friend of mine; I respect them too much to buy them something hokey or "Made in China," and I didn't really have the budget for anything more beautiful or authentic. One day, though.

Aside from getting back into touch with some skills that I think every doctor should have, I've also got a taste of what life is like in this climate. As I said before, I don't think that modern living - heated homes, fresh fruit year-round, institutional education, top-of-the-line medical care an hour away - is really sustainable up here. That last point was driven home to me today when I was told that one of the medevacs coming in to the ED was from Ontario, and that OHIP didn't cover transport costs.

"It doesn't?" I asked, feeling like I should have known that.
"Yeah. You know how you get taken to the hospital, and then you get an ambulance bill for like $200, and you're like wow, that smarts. This guy's gonna get a bill for $15,000."
"Is that how much a medevac costs?"
"Yep. It's not cheap."

The climate, the distances, the low population density, all militate against it. Gas in Yellowknife is at around $1.16/L. As the price goes up, as it must, thing around here are going to have to change. Maybe Northerners will have the ingenuity to solve the problems, but maybe they won't.

My trip here was Socratic, in the sense that I realised how little I knew. I have a fairly solid grasp on the general history and politics of many Asian peoples, and an inkling about South America, or so I hope, but I have understood thoroughly here that I don't know squat about Aboriginals in Canada. I couldn't tell Doghrib from Vietnamese if I didn't know the origin of the speakers.

In some ways, I fear for the Dene. Their language is disappearing - most of the adults speak fluently, but lots of the kids don't. I'm happy about Yellowknife's diversity - I was driven from the Islamic centre to the Hospital today by a Jordanian telecom engineer whose wife is an IMG, applying for a Canadian medical license. The growth of those ethnic communities though, seems like it could grow into a second wave of colonization. I pray that the new immigrants (especially the Muslims) don't mimic the attitudes of the Europeans who came before them.

Enough pondering for now, though. I'd best be on my way.

Ugliness and Beauty

Gets dark around here early,
Sometimes the moon, it'll follow you in the middle of the day.
Waiting to be found, we were just standing around,
With nothing really much to say.

- Last of the Ghetto Astronauts, The Matthew Good Band

It has gotten cold in Yellowknife. When I arrived here 11 days ago, I was surprised at how balmy it was. Though the skies were grey, the temperature was above zero, and for an Ottawa boy that's practically t-shirt weather. I went to work without my coat to avoid arriving there drenched in sweat. Now I shiver even though I bundle up.

Out on Frame Lake

A woman came into the ED today with cold exposure. Her temperature was normal, so she wasn't really hypothermic, but she had severe frostbite on the soles of her feet and both hands. Apparently well known to the staff, she and her common-law husband were homeless, but lived as vagabonds in the true sense; wandering around and between towns, pitching a tent and sleeping on the ground. She was a chronic alcoholic, with a median nerve palsy sustained from a failed suicide attempt. "She's hard on herself," said the day-shift doctor.

Her story was hardly unique. While most emergency rooms have a couple of regular alcoholics, given the size of Yellowknife, Stanton has a huge number of them.

A year or two ago, a partly aboriginal classmate of mine was involved in remaking the aboriginal health curriculum, and I asked her what she wanted the focus to be. She said "I don't want people to think of the stereotypes when they think of aboriginal health. You know, the obese, diabetic, alcoholic, suicidal aboriginal." Here in Yellowknife, I learned that those stereotypes exist for a reason.

On Tuesday I drove down to the nearby town of Rae with two physicians. Rae is almost entirely Dene. Aside from alcoholics (some of whom were recovering) I encountered my first case of child sexual abuse. It's the sort of thing they teach you about in medical school, but which you don't expect to see until you've been in practice for several years. "I diagnosed a seven-year-old up here with an STI just a month ago," said one of the physicians, himself a graduate of the class of 2004.

We left the case in the hands of the local social services, and headed off to visit the local elders' home. Even before medical school, I had been to a lot of old folk's homes, and they generally have a particular atmosphere, even a particular odour that tell you "this is a place where incontinent, demented people are sustained by purreed vegetables, Ensure, and inconsistently caring staff."

This place was different. The residents I saw were, first of all, all on relatively few medications, mostly of sound mind. All the staff spoke Dene languages, and treated the residents with a kind of respect I haven't usually seen in such a facility. Although I needed an interpreter to take all the histories, they were relatively easy patients to sort out. The food even smelled good.

I had noticed, however, on the walls of the room of one 94-year-old resident, a multiplicity of catholic icons. The words of an early Malcolm X speech came to mind "You look on the walls of any of those churches, and what do you see? White people! God white, Jesus white, Mary white, everybody white! . . . You listen to hymns like they taught my own mother; 'Wash me white as snow.' " The Dene of Rae might be responsible for some of their own problems, but somebody had taught them to hate themselves.

Back at the clinic. Social Services had talked to the mother, and put in place a "safety plan" for the abused child. The doc who had discovered the problem was beside himself. "It is obvious that she is being abused. [it was indeed obvious] I'm not making any accusations, but there's a male in the house, and mom's a known alcoholic. Even if the abuse isn't happening at home, this child doesn't need a safety plan, the child needs to be put somewhere safe!"

"Well, there are some historical issues around taking aboriginal kids away from their parents," replied the lady with Social Services.

Nobody could deny that there weren't, but the perverse result of the acknowledgement of that history was that an aboriginal kid was getting less protection than she would have had she been white.

On the drive back to Yellowknife, I got an education in "Indian and Northern Affairs" to quote the Government of Canada. "When you live up here, you realize just how unrealistic some of the stuff we tell people to do is. 'Eat more fresh fruits and vegetables.' What vegetables? An old Inuit man in my practice once told me 'My wife bought a pepper this week . . . it cost her $15.' We tell them 'Get more exercise.' Where are they supposed to do that? There are no gyms."

"Well, what were they doing before Europeans arrived?" I have a habit of asking questions that I already know the answer to, but I wanted to hear it from someone who had actually seen it with his own eyes.

"They hunted, they ate dried berries, and they were active because they had to be."
"So maybe you should tell your patient to get himself a spear."
"People like TV too much. It's a little too late to go back to that. The world has changed. They just haven't adapted well. They just haven't adapted well."

I personally don't think that the modern lifestyle is sustainable in the North, but that is something I'll hopefully write about another day.

It was dark by the time we got back into Yellowknife. Since my trip here has been phenomenally cheap, I was in the mood to have some good food. One of my companions referred me to "Taste of Saigon," supposedly the best Vietnamese food in town, and next door to "Fuego" supposedly the best desserts in town. The former was nothing to write home about (and so I won't!), but the latter delivered, and then some. The live music was also oddly memorable. My brother asked me on the phone "So if you were told that you had to practice in Yellowknife, would you be sad?" No sadder than if I were told I had to go to Calgary or Winnipeg. This town has a few things going for it.

The Maple Crème Caramel - a memorable dessert!

Prelude Lake, NWT

Sunset over Prelude Lake

One of the nice things about Yellowknife is that you don't have to drive far to get yourself into the wilderness. A friend of mine whom I met through the intergenerational gala in London said that I should get in touch with her daughter who has been working as a community nurse here in Yellowknife since the late '70s. After I phoned her up, she immediately invited me to spend the afternoon with her husband and her at their cabin at Prelude Lake. Since I have found that my life gets simpler if I take everything at face value, I accepted and was off with them the next day.

Myself, the couple, and their new dog Ernie drove out of Yellowknife yesterday, with them pointing out notable landmarks along the way. We passed the remains of the Giant gold mine, now the site of a giant environmental clean-up. The owners ran out of money and abandoned it, leaving piles of arsenic for someone else to deal with, that someone else being the public. That's called socialising risk.

Their cabin was apparently the first one on Prelude lake, but the land is all Crown land and is therefore all leased from the crown. "There are a lot of unresolved land claims issues around here, so the Crown won't sell you land, but gave us a 30-year lease. It will be up in a little while though."

"So, effectively, the Crown won't sell the land because they're not sure if it's theirs to sell."
"Yeah," one of my hosts laughs "that's basically it."
"So has anybody put a claim on this spot?"
"Not that I know of, but if people really got serious about this land claims thing, then somebody might."

We arrived at the base of a set of rocky hills. The landscape around here is what the locals refer to as typical "Shield country" - smooth grey hills of rock topped with shallow-rooting trees, interspersed with patches of muskeg and lots and lots of lakes and ponds. We hiked uphill towards their cabin, with Ernie the dog running around between the trees excitedly. I stipped them to go back and get my camera. It sort of spoils the spontaneity of things when one is constantly snapping photos, but I couldn't come out here and not get a few.

We go a little further until we come to their cabin. Ernie runs up to me with a stick, but when I take it from him he refuses to let go. The whole time he's been chewing on every straight piece of wood he can find. It's amazing that he doesn't have splinters in his mouth.

After hanging around the cabin for a bit, we go for another short hike along another trail, until we come to a beaver pond. Ernie runs right out on to it, and my host carefully takes a couple of steps, stamps his foot down hard, and says "Solid." There are two beaver lodges on this pond, but no breathing holes to be seen. We speculate on whether or not the beavers are even home. Ernie runs up to me with a stick again, and I give it a pull. His paws get no purchase on the smooth ice and he slides towards me. I let him out a couple of times before pulling him back in. Not the brightest animal I've ever met.

We march back up the rocks and then through the trees towards the truck. I'm impressed at how well my hosts know these woods, but then they've been here a long time.

After some tea in the truck, we head back out towards Yellowknife. Before we hit the highway (with a 70kph speed limit, enforced by the wisdom of the drivers), some white birds with fat white feet hop out on the road ahead of us.

"Ptarmigans! They're usually not so bold. Do you want a picture?" I do, but the battery on the camera gives out before I can get one. A few minutes later, they flap away, the black tail feathers contrasting sharply with the rest of their white winter plumage.

Somebody else's photo of a ptarmigan

On the drive home we talk a bit about her experiences as a nurse up here. "So do you find that the culture makes to take a different approach with aboriginals?"

"Well, I've been working with them for 30 years, so I don't really notice anymore. If anything, they've changed over the years; more of them can read and write, and more of them speak English now.

"They have a different relationship to time. If you ask them how they've been coping with their illness, they can tell you how they are feeling at that exact moment, but you really have to dig hard if you want to know how they've been feeling over the last week. And they don't understand why you need to ask them so many questions. They say 'Well, you're [. . .] supposed to know what's wrong with me.'

"Some of them are also suspicious of Western medicine. They're very selective in what they'll take and what they won't."

This didn't sound to me to be a major difference from every other patient I had met, but I didn't interrupt.

"The other thing about them, though, is that they're very forthright about herbal remedies that they are taking. A lot of them use spruce gum for wounds, for instance, as well as willow bark and ratroot as analgesics."

"Do they work?"

"I don't know. Well, willow bark is known to be analgesic." Of course, it was the original source of ASA. "As for the others, I don't know. Somebody really should study it."

My hosts dropped me at my door, and made me promise to contact them if I was ever in town again. I certainly would. Unfortunately, a lot of the photos I took aren't uploading well to blogger; I suspect I'll have to fiddle with it later.

Though the day was clear, the night was cloudy; despite the penumbra around the moon, I went out around midnight to see if I could see anything in the sky. Much to my chagrin, there was nothing of note.