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A quiet day at the office

They treat a lot of injuries at the Whistler Health Care Centre, in addition to offering translation services, bartering for payment and saving ski suits

It’s a knee day today. Hard packed runs and slushy lower slopes are keeping the Whistler Health Care Centre’s ice machines running overtime, chilling the aching limbs of the day’s mountain casualties.

Throughout this midweek spring day at the centre, a steady flow of wincing skiers and snowboarders hobble through the door, clutching their swollen knees. Some have made it painfully down the mountain by themselves. Others have been driven here by the mountain’s walking wounded delivery service, Truck 70.

The nurses say they often get days like this – days of shoulders, of wrists, of injured Mexicans, Italians, Brits and Canadians.

In the emergency ward, RN Linda Henderson is the first nurse to arrive. Linda has been caring for Whistler’s sick and injured since 1985, when the health care centre was just a trailer. The current two-storey building, which opened in 1994, has 55 staff and often more than 100 patients a day.

As charge nurse for the day, Linda arrives when the centre opens at 8 a.m. Today she’ll work with the ward clerk to control the patient traffic through the emergency ward and care for the bewildering range of injuries and conditions a day can bring.

Linda says she likes the early shift – the mornings are quiet and since she finishes at 3:45 p.m., she can usually escape before the late afternoon rush.

At 10 a.m. RN Anne Fenwick arrives to start her shift as triage nurse. The triage role is one which the staff and patients are still getting used to. It was only created in December when an emergency reception desk was built as part of the centre’s $680,000 renovations. A further government grant of more than $8,000 also helped to pay for training.

Every patient who walks though the centre’s front doors between 10 a.m. and 6 p.m. and asks to see a doctor now talks to a triage nurse first. She will take their details and assess how urgently they need treatment, taking into account the condition of people already waiting. It’s also a hands-on role – Anne cleans up wounds, checks pulses and quickly examines some splinted limbs before giving patients a code number indicating the urgency of their case.

It’s hoped that the triage service can be expanded in the near future so that the emergency reception desk is staffed throughout the centre’s 8 a.m. to 10 p.m. opening hours.

Anne believes the role is already proving valuable for both staff and patients.

"The girls on the front desk enjoy the support," she says. "And it’s great for patients to see someone with medical knowledge as soon as they get here."

Watching patients make their first contact with Anne, their attitudes are as varied as their injuries. Some are flippant and almost embarrassed about their swelling wrists and thumbs. Others are in pain and clearly shocked that their day on the slopes has come to an abrupt halt.

"I can understand why people get upset," says Anne. "Some of them have been saving all year to come here and if they hurt themselves, especially on the first day, it can be devastating. Then there’s the feelings of guilt, that you’ve ruined the trip for the whole family by getting injured."

Another challenge the triage nurse faces is the language barrier. A Japanese teenager arrives and asks to see a doctor. He doesn’t seem to be in too much pain and Anne tries to explain to him that if he sees a doctor, he must pay the bill himself and reclaim the money from his insurance company. His English is limited and he looks a bit confused. Anne calls a local Japanese translator to explain the procedure to him over the phone. Minutes later two Japanese snowboarders arrive with their friend who hasn’t felt well since he hit his head – they speak even less English so the translator is asked to come in. It’s turning into a Japanese day too.

About a third of the patients seen in the emergency department have come from other countries. A Japanese interpreter is often in the building and the nurses occasionally have use a book translating medical terms into six different languages. Sometimes they’ll scour the waiting room for other people who speak the same language.

Even when they do speak English, getting patients to pay for their treatment can also be a trial. With patients coming from all over the world, dealing with insurance companies directly would be a huge task, so the centre takes payment from patients directly. This can take some explaining and not everyone takes to the idea graciously.

Head nurse Francesca Cole reckons that about 80 per cent of patients pay their medical fees without a fuss but many others are shocked at the price (between approximately $400 and $800 for a fractured wrist, for example). A significant number say they can’t pay because their credit cards are maxed out.

"We’re very flexible and we do a lot of negotiating," explains Francesca. "The most important thing is to get the injury looked at. Payment is secondary. Sometimes if it’s a young kid from another country we say, ‘Why don’t we give Dad a call and see if he’s got a credit card number we can use?’ Or, ‘Why don’t you leave us your snowboard as a goodwill thing and you figure out how you want to do this. Maybe you could get a credit card number from your insurance company’."

She says Canadians who have come from another province for longer than a short vacation can also face problems in covering the cost of their treatment.

"If you’re going to be leaving your province for the season to come to B.C., you have to let your insurance company know. If you just come out here and have to be seen two or three times, your insurance company back in Ontario might say, ‘Oh you’ve moved to B.C., we’re not paying for this’."

Injured children can also present another array of problems. A five year old in a ski school class who falls and screams that he’s got a sore leg might be more scared than injured. The medical staff have to decide whether they should look at the child and have to present the parents with a bill even if the child isn’t hurt.

This morning the TV room resembles a youth club. A young ski instructor is trying to keep three injured Ski Scamps occupied. They’ve all been treated by the doctors and are waiting for their parents to arrive.

"The mountain staff are fantastic," says Linda. "That instructor has been with them all morning and he’s even brought them food from McDonald’s."

Keeping the young gang in the TV room also helps free up space. At busy times Linda admits they have to play musical beds in the ward, sometimes moving the most mobile patients two or three times to make room for new arrivals. Sometimes patients still end up lining the walls in chairs and on trolleys.

But no matter how badly injured they are, it seems that most of Whistler’s injured skiers and riders have more than their health in mind when they’re being treated.

"The one thing people always say is, ‘You’re not going to cut off my clothing are you?’" laughs Francesca. "We rarely do that – the only ones who have their clothes cut off are the ones who might imminently die on us or if it’s a particularly difficult piece of clothing we can’t get off. I’d say 95 per cent of ski suits and ski boots come off. I remember one lady who had a fractured femur and said ‘I don’t care how much pain it causes me, I do not want the ski suit cut.’ So we had no problem getting that suit off. But we do give pain medication before we try to get them off."

By lunchtime around 40 patients have been through the ward and the centre’s nine beds are full. "Oh this is a quiet one," says Linda.

But there’s no time for sitting around. Linda is teaching one of the many "knees" how to use his crutches. The porter is helping a doctor reset a fractured wrist. One of the centre’s dedicated volunteers, Shirley Laidlaw, is changing beds and cheerfully wheeling patients around.

The atmosphere is relaxed and friendly. Most of the staff have lived in the area for years and staff turnover is low.

"I love my staff here because they’re very motivated," says Francesca. "They really care – because it was such a small place before they’ve all grown with it. They’re very interested and whenever we’re starting a new program there’s never a problem motivating them to try something new."

The patients obviously notice it too – a huge bouquet of flowers has arrived from an appreciative patient treated the previous day. Francesca says they get lots of letters and cash donations from people they’ve looked after.

Today Blackcomb ski patroller Andor Tari is also lending a hand in the ward. All the patrollers on Whistler and Blackcomb spend one day a year in the ward, seeing what happens to the people they help on the mountain.

"It’s great to see the follow up," Andor says. "The physicians grab you and take you with them to see the patients and explain what’s happening. The doctors on the mountain also help us brush up on our skills,"

Andor still has his mountain radio on, listening to patrollers discuss the people they’re treating on the mountain right now. I hear the words "terrain park" more than once. It’s a notoriously busy spot for the patrollers as skiers and riders constantly push themselves harder and higher. Some days the patrollers just move around the park seeing to one crumpled victim after another.

Both Linda and Francesca agree that the hard packed conditions in the mountains this year have also caused more serious injuries.

"This year has been particularly hard," says Francesca, "In January and February it was icy and on those really cold days everything was breaking. Bones were just going snap, snap, snap! We saw an incredible number of fractures, especially wrist fractures – we would have to reset up to 10 wrists a day, and that’s not including the ones that just had to be cast."

To compare their workload to previous years, from April 1, 1999 to March 31, 2000 the emergency ward treated 22,148 patients, including 2,197 snowboarders and 3,063 skiers. From April 1, 2000 to March 31, 2001 they treated 22,861 people. Of those, 2,039 were snowboarders and 2,189 were skiers.

These mountain figures might not include people who walk in to the centre two or three days after an accident and don’t tell the reception staff how they hurt themselves. But when the nurses are told of the stats, several are surprised that there are still fewer snowboarders than skiers getting hurt – they thought it was the other way round. But the gap is closing and since there are still fewer snowboarders than skiers on the mountain, they do seem to have a higher chance of ending up in the health care centre.

In the summer and fall, the centre’s nursing numbers are half their winter level. Some October days the emergency ward will only see around 30 patients. Some of the casual staff work in hospitals in Vancouver and Pemberton and return to Whistler for the winter season. There are also fewer doctors and ambulances on duty.

But within the busy periods there’s not much of a pattern, except during the holidays, both US and Canadian ones. The busiest day of the year is always New Year’s Eve – the only time that the centre is open 24 hours. This past New Year’s Eve, the staff treated between 20 and 30 people during the night.

"It was kinda nice this year," says Francesca, "The year before there was a lot of alcohol and drugs, a lot of ecstasy. We didn’t see the drugs this New Year, and that was good."

Apparently the holiday excesses also lead to chaos on the slopes on Boxing Day and Jan. 1, as people try to clear their hangovers and sleepy heads with some mountain action. However, they’re not concentrating and some unfortunately end up in the emergency ward.

The stats don’t reflect all the work the centre and its staff do either. Many community and support groups use the building and the centre has funding for its own sexual health clinic and an annual Condom Sense program in the fall. Francesca says the two weekly SAFE clinics (supplying HIV and STD testing and birth control counselling and supplies) have proved a huge success, seeing up to 40 people a night – many of them young men.

But despite all their hard work, Francesca believes there’s one group of people in Whistler who are slipping through the support net.

"I think we’re seeing most of the sexual assaults but we aren’t seeing the girls who have maybe been slipped something in a bar and have woken up in a strange place with a strange person. These girls should be coming in to get tested and telling the police. The police can’t fight something they don’t know is happening."

Francesca admits that she doesn’t know how to get women who’ve been assaulted in this way to come forward. But she is trying to highlight the problem at the SAFE clinics and at mountain orientation sessions at the start of the winter season.

The centre also funds a sports program which promotes safety and the use of protective equipment in both summer and winter activities. Francesca says the increasing number of skiers and snowboarders wearing helmets is a welcome trend. She illustrates with a couple of examples from her own experience.

"One guy came in here, he’d had a bad fall in the terrain park or something, and he had a concussion – a pretty good one, and he had been wearing a helmet. And I thought ‘Wow, what would that concussion have been like if he hadn’t been wearing a helmet?’ The other guy had a nasty laceration, I think he hit his head on a rock. He got it with the helmet on and I guess the helmet had gotten pushed forward a bit. But if he hadn’t had the helmet on how much worse would it have been?"

Back on the ward, Andor hears the patrollers on Blackcomb discussing, by radio, plans to evacuate an injured female snowboarder off the mountain by helicopter. They will still phone ahead to warn the centre to expect her but Andor gives the nurses and doctors a little more advance warning and they start to prepare a bed for her.

At 3:45 p.m. – approximately 70 patients after she started (including 15 sore knees and seven wrists) – Linda is finishing up for the day. The place is still busy and she asks the other nurses whether they need her to stay. They say everything’s under control and another staff member takes over as staff nurse until closing time.

At the emergency reception desk, Anne is juggling a flurry of late afternoon arrivals and keeping an eye on patients in her observation beds.

Another young Japanese snowboarder hobbles in with his arms round his friends’ shoulders. One leg of his pants is rolled up, revealing a nasty cut. He waits patiently in line while Anne takes details from another new arrival.

Truck 70 is also back.

"Hopefully this is the last," the driver says as she points a separated shoulder and a fractured wrist in Anne’s direction.

In the room next door, ultrasound technologist Julie Hall is also having a busy day. She began seeing patients with the centre’s new $150,000 ultrasound machine at the end of March. She says the patients she’s seen so far have been excited about having the machine in Whistler. It saves them a long round trip to Vancouver or Squamish.

The injured female snowboarder has now been flown off the mountain and is being attended to. The doctors are concerned about her injuries – she’s got a badly fractured wrist and might have ruptured her spleen. They’re arranging for her to be taken to the city by ambulance for more treatment.

The closed curtains and serious voices highlight the reality of how serious a fall or collision on the mountain can be. The incident is also a reminder that while seriously ill and injured people are brought to the centre for treatment, it’s not a hospital and there are many things the staff do not have the equipment or the training to do. The worst cases still have to be driven or flown elsewhere for more specialized help.

The nurses say that seeing mountain casualties day after day has made them more defensive on the slopes. Their children never hear the end of it either.

And if you’re ever in any doubt about giving that last run of the day a miss, take a peak in the waiting room at about 4:30 p.m.. You’ll soon see that that final half hour might be better spent in the pub.



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