Thanks for your patience on waiting for Season 2 to drop. This episode will be about End of Life Care, regarding a patient I followed and how I felt things went. I'll talk about challenges with personnel and interagency collaboration/cooperation, obtaining medications and work arounds, provider/family/patient dynamics in an end of life/palliative situation, and lastly some lessons learned. I hope you enjoy.

In this episode, my weird sh*t magnet got stuck to my forehead yet again as something that appeared simple turned out to be anything but. Two patients, one sick, the other seemingly not so...turned out they were much sicker than the one that was sick...with profound hyponatremia, hypokalemia, hypochloremia, hyperglycemia, acute kidney injury and renal failure. I'll talk briefly about how slow mental processes get at Zero Dark OMFG in the morning, which can lead to overthinking as not to miss something/mess something up, as well as some decision paralysis that can accompany that...

So I'm doing my Advanced Trauma Life Support course and it's being run where I did my trauma medicine/surgery rotation in PA school...and some of this is bringing up/back some odd feelings that I'll be discussing => some good, some uncomfortable.

In this episode, I'll discuss a case of sepsis that presented much like a PE, the cause of which surprised all of us involved.

In this episode, I'll be discussing a case of a gunshot wound in the new remote community I've started working in. I'll discuss the case itself, results, as well as some general considerations when dealing with gunshot wounds, both in the physical sense as well as the bigger picture regarding safety of your patient and around the medical complex in a rural site.

In this episode, I'll be discussing a case of eye pain/decreased vision that presented here and the difficulties we have in certain places trying to sort out and manage ophthalmic conditions without proper equipment and sometimes abilities to get people out.

Intro - I'd like to start off by apologizing for taking so long to get back out here. Thanks to everyone that listened to my first episode, I hope you come back now that I've got this new one out. Special shout out to the listener from Samoa that made this the #1 Health Podcast in their region for a few days!! Land Acknowledgement - I recorded this on Treaty 6 Land, homeland of the Oji-Cree, Ojibway, Cree, Dene and Inuit peoples and the place where I'm employed to help care for some of these people. Topics - Remoteness, Patients, Health Issues/Social Determinants, Administrative issues. I work in a fly in community in Northeastern Manitoba, roughly 600km from WInnipeg, which is the main health care referral centre for us. There is an ice road here in the winter, but for the most part things are flown in, including health care providers. Unfortunately, this also means patients often need to be flown out. Patients are often complex - it's a rarity when something is straight forward. They're also often difficult to contact, sometimes reluctant to come in. They're also sometimes quite reluctant to be sent out, even if they really need it, as they're concerned about family separation, especially if people are critically ill. There are a lot of health issues here that revolve around diabetes and hypertension and the downstream effects from those. There is a dialysis unit here due the kidney disease burden here. There are a wide variety of infectious diseases here - MRSA skin infections, TB, syphilis and other STI's. There are some issues with substance use/abuse as well. Housing is an issue here - there is often a lot of crowding within homes, water comes from holding tanks or cisterns. Food is expensive here, particularly fruits and vegetables. There are many admin challenges here - paper charting, formulary issues, patient movement and transport, who's going to pay for things people need. An often tiring issue is finding a hospital/ED to accept patients, since most of them are getting hammered due to bed blockages. Despite all this, the work is very interesting and rewarding. Take care and see you next time :-)