Dec 12, 2019, By: Laura Eggertson
Half an hour after starting her first shift at a remote, 45-bed hospital in Uranium City, SK, Sue Hotson delivered her first baby.
She was terrified. A 24-year-old nursing graduate from Cambrian College in Sudbury, ON, near where she grew up, Hotson had never even performed a pelvic exam, much less delivered a baby.
But the baby was coming. So, with the help of a more experienced nurse to guide her, Hotson kept repeating what has become her mantra throughout 42 years of nursing in isolated hospitals and clinics across Canada’s North: “Just don’t let it hit the floor.”
Since that first night in 1977, when the doctor arrived just as the baby did, Hotson has delivered close to 100 babies. She’s assisted in the births of hundreds more.
It was a swift learning curve for the nurse, who once told an instructor she’d rather go on welfare than work maternity, after being bullied by nurses on the maternity ward where she trained.
Unlike her colleagues in urban Canada, Hotson has not had the luxury of choosing a nursing specialty. In Uranium City, in McLenna and High Prairie, AB, in Watson Lake, YT, in Iqaluit, NU, and in her current job as a nurse and site manager at the Stikine Health Centre in Dease Lake, BC, Hotson has treated whatever illness or injury came through the door.
Often, she’s been the only nurse on duty during a shift; sometimes, the only health care professional available.
Learn the basics
She’s learned to love the surprising variety of Northern nursing. An unflappable nature, a good sense of humour, and confidence in her nursing skills have helped her cope with the unexpected—traits she believes anyone interested in a similar nursing career should have.
She recommends a year or two of emergency or medical/surgical nursing, because that is the bulk of the job in small communities.
She’s learned to love the surprising variety of Northern nursing.
“You know what you need to do, do it well, and make sure your patients are well cared for. You won’t become an expert at anything, but you’ll certainly become good at everything,” she says.
From breech births to shootings, helicopter blade injuries to house fires, and car crashes to suicides, Hotson has responded to trauma and routine illnesses. Along the way, she earned her BSc from Athabasca University, an Advanced Certificate in Emergency Nursing through the BC Institute of Technology, and a Certificate in Forensic Science from Calgary’s Mount Royal University.
She’s made lifelong friends, learned to play a mean game of Scrabble, devoured shelves of murder mysteries, hiked to breathtaking wilderness vistas, boated on pristine lakes, and listened to countless hours of country and bluegrass music.
Until his death in 2017, Hotson’s partner through it all was her husband, Alan. Their relationship was the reason she could live in such isolated circumstances.
“We didn’t need a lot of outside stimulus, no matter where we lived. We’d go to work and spend a lot of our time together,” she says.
For the last 20 years, Hotson has worked in Dease Lake, a town of 400 people in BC’s Northern Interior, just south of the Yukon border. The Stikine Health Centre serves 2000 people living in a geographic area the size of France.
The closest hospital, airport, and shopping centre are a seven-hour drive south to Terrace, BC, or a nine-hour drive north to Whitehorse.
“You have to be prepared for anything that comes in, and know you’re not going to get a whole lot of help for quite a while.”
The primary care clinic Hotson manages is open 8:30 a.m. to 4:30 p.m. Monday to Friday. Two doctors live in the community and another comes in, and there are 2.5 nursing positions, as well as a combined lab/X-ray technician. A doctor and nurse are on call after hours and on weekends.
Serious emergencies are flown out via air ambulance. But when the weather is bad and air ambulances can’t get in, Hotson and her team make do. Hotson can take X-rays and run lab tests when needed. She’s delivered a baby in the back of a plane, and in an ambulance stuck in a snow-covered ditch.
“You have to be prepared for anything that comes in, and know you’re not going to get a whole lot of help for quite a while,” Hotson says.
When there’s a difficult emergency, everyone is called to help.
Family answers phones
Twelve years ago, that emergency was a house fire.
Hotson got the call at 5:30 a.m. on a weekend. She rushed to the clinic, along with the town’s only doctor at the time, to receive a mother, father, and a 14-year-old boy. All were suffering from smoke inhalation and the adults from serious burns.
Hotson called the community’s other nurse, a single mother who took her children to stay with Hotson’s husband so the nurse could get to the clinic. Hotson then pressed her patients’ family members into service answering phones.
After assessing the patients, the doctor and nurses intubated the father, with the ambulance crew pumping the bag to manually resuscitate him.
They then intubated the mother and had just moved on to the boy when the pediatric team arrived via air ambulance and took over.
Six hours later, they had stabilized the patients and flown them out. All three patients survived.
The fast pace and the teamwork of colleagues and community members are also what Hotson loves about nursing in the North. “You build really close relationships,” she says.
Critical community support
Living in a small town has been challenging, though, because of the need to maintain some professional boundaries. She’s found a way to make a few close friends and to be friendly with the rest of her patients, while socializing mainly with her husband.
Her community ties became crucial, though, when Alan developed Alzheimer’s. Hotson cared for him at home for three years while working full-time. With their son, Michael, living in Pictou, NS, Hotson relied on both her nursing skills and her friends.
The doctors made home visits. Friends checked in on Alan. A home support worker visited twice a day.
“It was really hard. I was always, always, tired,” Hotson remembers.
She slept on a mattress at the foot of the hospital bed in their living room, for the times Alan fell and she couldn’t get him up until morning.
When Alan died, while in Smithers, BC for respite care, it was a blessing for him, Hotson says. He would have had to go into a nursing home. But she can’t bear to live in the retirement home they’d bought in Nova Scotia, so she plans to sell it.
“I knew him for 50 years, and we were married—churched—for 45 years. We were happy, just the two of us.”
When she retires in early 2020, Hotson plans to travel. She’s not sure if she’ll return to nursing, but she took courses in forensic science because she hopes she might work in a provincial coroner’s office.
Of course, she might also go back to work.
“It depends on how bored I get,” she says with a laugh.
Laura Eggertson is a freelance journalist in Wolfville, NS.