"He’s my son, Joe . . . I might kill him”
Here is the gripping account of a young Arctic doctor whose practice spanned a thousand miles of ice and muskeg and who often had to diagnose and operate by radio
Chesley Russell, a hypodermic poised over his boy’s head, cried into the microphone . . .
DR. JOSEPH P. MOODY
I DIDN’T really know what was expected of a general practitioner in the Arctic—and I certainly didn’t expect that it would include diagnosing and treating patients hundreds of miles away by radio. In spite of that, or possibly because of it, my Arctic practice was a fascinating and unforgettable experience and next year I’m going back.
I was thrilled when my application for a post as a medical health officer in the Department of National Health and Welfare was accepted and I was assigned a territory of six hundred thousand square miles sweeping west from Hudson Bay. My headquarters was to be at Chesterfield Inlet, one thousand miles straight north of Winnipeg, and I was to be the general practitioner for whatever was living and within my reach, regardless of whether it meant moving across the wastes by canoe, plane or dog team.
The system worked quite simply, once the initial shock wore off. All through the Arctic the Department of Transport has its radio transmitters. There were also the “senders” of the Royal Canadian Mounted Police and, as in-between links, one could rely on the radio equipment of the Hudson’s Bay Company trading centres. In addition there were the weak individual senders of prospectors, trappers and research men who happened to be in the area. Obviously, doctoring by radio could not have been a success without the continued and devoted co-operation of all the inhabitants of the region. The fact that, throughout the area, across miles and miles of barren land, there would be people breathlessly following every move you made did cause a certain amount of stage fright, but the help that could be rendered by those same people sometimes gave me the reaasurance that, after all, I did not face it quite alone.
What did bother me, though, was the realization that I would have to live under the strain of having to do the right thing on a long-distance basis. I am one of those doctors who takes his work very seriously, who grieves for a long time if anything goes wrong, and who feels a personal and lasting loss when death occurs. I dreaded the arrival of the first telegram asking me to get on the air, first to diagnose from a summing up of symptoms by an inexperienced layman, then proceed to explain the steps that might lead to recuperation and satisfaction or death and despair.
A great help was that a supply of drugs and basic instruments had been placed at nearly all posts and communities and that I had a record of what was available. This enabled me to make the best of it in most of the cases I had to deal with and also to utilize t he medication that was at hand.
A brief telegram announced one of my first cases soon after I had settled in the northland:
BABY RUSSELL AGE FIFTEEN MONTHS TEMPERATURE 103 PULSE 120 HEADACHES MIGRAINE TYPE HAD A COLD FOR WEEK STIFFNESS IN SHOULDERS AND NECK SPINE SEEMS TO CURVE STOP LOOKS BAD MOTHER DESPERATE PLEASE CONTACT BY RADIO HBCO ESKIMO POINT
It was from Chesley Russell, the manager of the Hudson’s Bay Company post at Eskimo Point, about two hundred miles south of Chesterfield Inlet. I had spoken to him over the air quite a few times before and we had kind of become friends.
The patient was his little boy, an only child and one of the few white babies in the Canadian Arctic. The case looked serious, and there would be no time for me to fly down and examine the boy myself. I immediately sent a wire telling him to get on the air at seven that evening so that I could speak to him. The Department of Transport had a strong transmitter in Eskimo Point and it looked as if we might Continued on page 56
Continued on page 56
ABOUT THE AUTHOR
Young Dr. Joseph Moody, with his wife Viola, took over a practice covering one-sixth of Canada’s total area when he graduated from the University of Western Ontario in 1946. In collaboration with W. de G. van Embden, he now describes some of his pioneering medical adventures from his three and a half years in the north. Another article will appear shortly.
CONTINUED FROM PAGE 31
be able to do it by radio-telephone.
I had little doubt about what was wrong with the boy. There had been isolated cases of meningitis among the Eskimos in that section and the symptoms described in the telegram were unmistakable. Meningitis is nasty, but there are cures. The crucial point was to determine how far the disease had progressed and whether it was at all possible to save the child. The curvature of the spine did not seem right, that might be due to inflammation ot the brain. I checked the drug list and found to my satisfaction that they had soludiazine in ampules, the medication that would have to be injected.
I got on the air at seven, but when I heard Chesley’s voice I suddenly could not bring out a word. 1 had mike-fright. Hundreds of thoughts played tag in my mind. I saw that my hands were shaking and I felt cold in the overheated radio hut. Charley, the radio mechanic, took the receiver away from me and made contact. When I heard him say, “What is that temperature?” 1 collected myself and grabbed the horn from his hand.
“Hello there, how is it now?”
“Oh, Joe, it’s real bad, the boy, he . . .”
The contact went dead.
“Hello, hello, Ches, are you there? Can you hear me?”
“Yes Joe, reception okay here, you having trouble?”
“Not just now, go ahead.”
“Doctor, it is like I wired this morning; he is stiff, arms don’t move. Temperature is 104 now. He has terrible pains. Can’t stop crying. What is it Joe, what is it?”
“Well, I think I know. But, say, what about that spine?”
“I don’t know, I really don’t. This afternoon it curved terrifically, was way off the bed.”
“Could it have been the pain, straining to get relief?”
“Could be, Joe, could be. The wife said that. He seemed to control it. What can we do, Joe?”
“Have you got some soludiazine there?”
“Do you have some soludiazine, the drug. And a hypodermic?”
“Hello, hello, are you there?”
“Yes, can you hear me?”
“Yes, what do you want me to do?” “Do you have soludiazine and a hypodermic?”
“Did you say soludiazine? I don’t know, Joe, what is that stuff?”
“Yes, soludiazine. It’s a drug. You have to inject it.”
“I—-what—oh, wait—Carl here says that we have it.”
“What kind of box is it in?” “Yellow, yellow with red lettering. Is that right?”
“Yes, that is right. It’s a fluid, hey?”
“Yes, sure, in little, little, ah. . .” “Ampules.” I helped him along. “Yes, that’s it.”
“Now listen, Ches, you take the top off that thing. You know how?”
“Yes, will do.”
“Say, how much is in that ampule?” “Hold it, let me see. It says two ce.” “Okay, is your hypodermic clean?” “Sure, comes out of the cotton.” “Fine, you take good care of things there.”
“Never mind. Now fill the hypo, the hypodermic, and get all the air out. You have the child right there, do you?”
“Yes, he’s here.”
“Good, now listen what you do, Ches. You know, on the child’s head, right on top, is that soft spot, the fontanel.”
“What do you want me to do there, Joe?”
“Can you find it?”
“Yes, I can.”
“Now look for the spot closest to the centre of the head.”
“Get it as far back as you can. Look for the spot closest to the centre of the head. Right?”
“Now you inject . . . wait a minute. What kind of needle do you have on that hypo?”
“It’s a thin one.”
“Okay, but what does it say on it?” “It says ... it says No. 24.”
“Fine. How long is it?”
“It’s real short, about an inch.” “That’s all right. Now you must inject that needle into the soft spot, very gently. Not too deep. And straight down.”
Silence. I den’t get an answer. My God, not now!
Dead, nothing happens. “Those damned sunspots,” I say aloud.
“What was that, Joe?” He comes through, must have heard me.
“Never mind, can you hear me?” “You want me to inject in the soft spot?”
“Yes, that’s what I said. Very careful, and keep the needle straight.” “I heard you, but Joe, that’s dangerous.”
“No, it isn’t . . . Just be careful.” “But, Joe, I can’t—I can’t. You don’t want me to do that, Joe.”
“Yes, I want you to do that.”
“But the soft spot is dangerous, Joe. They all say it. The wife says it too.” “It isn’t dangerous. You can do it. Just steady. I’ve done it hundreds of times.” That was a lie, but I had to get him over his fear.
“He’s my son, Joe, I could kill him.” “You want him to live, don’t you?” “Yes, but—.”
“Then do it. Now listen carefully. As close to the centre of the head as you can. Push it in very carefully. Not all the way, just about three quarters of an inch. Do you hear me?” “Yes, three quarters of an inch.” “Okay. Push it in and then empty the hypo slowly. And don’t move it. Keep it perfectly still.”
“I can’t, Joe. I’m shaking.”
“Then get yourself together. Go ahead now. Do it.”
Bill, the Mountie, takes the receiver at the other end. “He is putting it in now, Joe.”
“Does he actually have it in?” “Yes.”
“Then tell him to empty it. Keep him steady, Bill.”
“Right.” I can hear Bill relay my instructions.
“Is he very nervous, Bill?”
“Plenty, but it’s all right.”
I notice that I hold my right hand as if I were injecting the child myself. I move my fingers and it hurts. I must have had them in that position for some time. I am shaking. I couldn’t do it now. I’d make a mess of it. Oh God, give him strength. Bill came in again.
“He’s got it empty, Joe.”
“And the needle out?”
“Yes, it’s out. One of the women fainted, Joe. Mary will look after her.” “Okay, never mind that. All the fluid is in, right?”
“Yes, Joe, it’s all over. How is the weather, Joe?”
“Oh, hell, don’t try to be funny. Give me Ches again.” The father gets on. “Are you all right?”
“I did it, Joe. It—it worked, I guess.”
“Good for you. Now listen—this should help him. It is an antibiotic; it should take the fever away. Tomorrow he should be able to feel those arms again. Not move them, just feel. If anything happens in the next few hours, get me on. I’ll ask the radio boys to keep the circuit open. Okay?” “Yes, Joe. I get you. God help me if the boy—I hear something
like a sniffle. Poor Ches had had a tough time. “Joe, what do we do about that woman, she’s out cold?”
“Ice water—just ice water.”
“Ha, ha, that’s right, that’s a good one. Will do, right now. You bet. ’By, Joe, and thank you Joe.”
“Okay Ches, let me know if I can do more. Just keep me posted. I’ll wire you in the morning. I’m signing off now.”
“Yes Joe, thank you, Joe.”
I sat back and searched my pockets for a cigarette. It was all over. I didn’t do too badly, I thought. I looked at my watch, the whole thing had not taken longer than half an hour. It seemed as if I had been on the air for hours.
Everything should be all right now. Then, suddenly, I jumped up. My God ! What had I done? I hadn’t asked for any more of the symptoms. Should have asked about vomiting, about the legs, the neck, the eyes, about swallowing. Sweat broke out all over me. I had just accepted the fact that it would be meningitis. What made me so sure?
I wanted to get back on the air but realized that it was useless. I could only wait. If I showed doubt now they would throw a panic. I must wait. I wouldn’t know anything until tomorrow morning—unless it got worse, of course. I even thought for a moment that I’d like it to get worse, just so that I could speak to them again. I had to know what was going on. But I knew that 1 didn’t want it to get worse. And it wouldn’t.
You were all right, Joe, I told myself. I got up and walked outside where the moon threw its greenish light across the ice of the bay. One of the dogs whined, then barked. I felt hot now and the snow-cold air refreshed me.
It worked. The following day Ches gave the boy another injection. The baby was fine within a fortnight.
Sometimes They Died
After I had treated many of these long-distance cases I began to wonder whether it really was a success. It was so difficult to check up. On minor complaints you might not hear anything again. If the case were serious I often had to order a plane in to get the patient to a hospital in Winnipeg or Montreal and then I lost contact. Asking the government for a plane was a great responsibility too. When you order a plane you ask the government to spend a few thousand dollars, sometimes more. 1 wouldn’t feel too good if I had sent out an acute constipation telling them that it was an appendicitis. And also I could have left people behind to die when I should have taken them out. I never saw most of these radio patients; some were in regions that I did not ordinarily cover. Those that were flown out were treated in big city hospitals and few of the doctors there were kind enough to let the radio diagnostician know that his conclusions had been correct and the patient survived.
There were cases when the patient did not make it. We had an old Eskimo with frostbite in his leg. Gangrene had set in and the leg had to be amputated, although there was a chance he would die from shock while it was being done. However, it did not get that far. I could not find anyone to perform the amputation. The Mountie on the post flatly refused and I could not blame him. The Eskimo died and I felt badly anyway.
Driven by the desire to find out as accurately as I could how my radio' diagnoses had worked out I went to great pains to try to check all the radio cases I had treated. I was surprised
to find that about seventy percent of my patients had recovered, about twenty-three percent had shown improvement and that only about seven percent had not made it for one reason or another. They might not have died, but they did not show improvement either. This survey was encouraging and after that I promoted the radio treatment as much as I could, suggesting various improvements and trying to regulate the transmitting schedule.
Another thing that made me grateful for the unlimited possibilities of the system was that, when I went out on patrol, I found so many appreciative people. The fact they could get on the air and reach a doctor in case of emergency, or just if they needed reassurance, gave them a tremendous amount of confidence. It was gratifying, too, to hear comments on difficult cases I had treated. Many people had listened in and had followed the case step by step.
“Gee, doctor, that was terrific,” they would say. “I could see it happen as if I had been there myself.”
“That was really something, doctor. Do you think he would ever have made it if you had not ordered a plane for him?”
“That was one baby who’ll never know what it took to bring him into the world. Pity about the mother, though, wasn’t it? But you sure couldn’t help that, doc.”
“You know, I never thought he would get that finger off. He ain’t so bright, is he?”
That last remark referred to the time I directed a trapper to amputate a frostbitten finger that had become gangrenous. He was a fine man, but a little mixed up and certainly nervous at the time. I’ll never forget that one. It went this way:
“Hello Jim, which arm is it?”
“The right arm, doc. No, no, I guess it’s the left.”
“Now, which one—right or left?” “It’s left, doc, sure it’s left.” “What? Gan’t hear you.”
“LEFT.” Wow, that one came through. I had to change the receiver to my other ear.
“Which finger is it?”
“The second from where?”
“From the inside.”
“What do you mean, nearer to the thumb?”
“No, the one next to the little one.” “Why didn’t you say so?”
“What? I did!”
“Never mind; do you have a scalpel?” “A what?”
“Do you have a knife?”
“I’ve got a jackknife.”
“Is it clean?”
“Well—I cut seal blubber with it.” “Boil it.”
“But, doc, it’s a good knife.”
“But the wood, doc, it’ll ruin the handle.”
“Boil it. We’ve got gangrene now; we don’t want a few more infections.” “It’ll ruin my knife.”
It went on for hours. This he did not have, that he did not understand, this he did not want to do, that he could not find. The bandages that he eventually found had been used to clean his rifle and I suspect that the antiseptic he should have had on hand had disappeared in the manufacture of liquor.
But he made it. Did a fine job, too. Cut off a digit, tied off a couple of bleeders and sewed the whole thing up neatly. The story was all over the Arctic.
I don’t know what happened to the knife. A-