With permission from this most adorable Yu'pik child's mother, I present to you my hat trick. I know you're not going to believe me when I tell you this baby was born shortly after I arrived this morning, but it's true. She arrived on the floor around 6 am and was 4 cm. I took over at 8 am, got my scrubs on and went to introduce myself. Yet again, 30 seconds after I uttered my name in introduction she declared it pushing time. I checked her at 0810: complete. Time of delivery of this little Alaskan morsel: 0820. Trifecta: priceless.
I mean seriously. How can you not want to squoooooosh those cheeks? It's nearly impossible.
And the excitement of the day continued to build. I took a call around 1 pm from a health aide in a village called Newtok. I didn't have her patient encounter form in front of me because I was eating lunch. She starts to tell me about a 42 year old woman there for a cough, some discomfort in her chest when she coughs (I'm thinking blah blah, no big deal). And she has fevers (yeah so what). And her temp is 101.8 (still not overly excited). And her heart rate is 140 (I stop chewing my lunch). And her blood pressure is 60/40 (mind is racing, starting mild panic mode). And her respiratory rate is 40 (inner monologue: medevac...fluids...early goal directed therapy...medevac). And her oxygen saturation is 90% (more of same inner monologue). I tell the health aide to start an IV and start running fluids. She asks me at what rate I would like her to infuse the fluids. "How fast can you squeeze that bag?!?!?" is my response. I run to find my fellow FP to figure out the whole medevac situation, all the while feeling vaguely like I was staring in some tv show. I give him the run down on the patient and he replies, "well, activate the medevac then!" I honestly felt akin to a superhero, ready to throw my cape over my shoulder and dart off into the unknown.
I called the medevac number and a nice man proceeded to ask me totally insane questions: "Will this be an ER to ER transfer?" Ummm. No. I said it's from Newtok to Bethel. Bumble to slightly less bumble. "Is the patient on a ventilator?" Uh. No. I don't think there's a ventilator in these parts for about 450 miles. And so on and so forth.
Fumblings aside, the patient made it to the ER and was being treated as I was signing out to the night doc. I'm sure there will be more to the story tomorrow morning. About 5 minutes later the other inpatient doc got a call about someone with likely spinal cord injury that needed the medevac. We rock paper scissored for it. No! That's not right. My lady got first dibs. The other doc told them to strap that guy down to a padded backboard 'cause it was going to be awhile (only 1 medevac).
As if my day could not get more exciting, the night doc had medevac'd (is that a word?) in a stab wound victim (attacked by his drunk cousin). We weren't sure if he would be headed to Anchorage, but either way all patients need to be stabilized in Bethel. He had a chest tube placed in the field (totally making some paramedic's day) which drained out 500 cc of blood, and was stable enough to be admitted to yours truly. The ER doc asked me if I had time to "throw a stitch or two into his chest" before taking him to the wards. How could I pass it up? I wandered around the ER for awhile trying to find the proper tools for the job. I then went to his bedside and removed the bandage (Yes, I know. I did this in the wrong order) to find a large, gaping wound (4 cm vertical by 4 cm gaping wide). Needless to say it took more than "a stitch or two." But it was a nice way to pass part of the afternoon.
And with that, I have rounded out my week of wards. Tomorrow I pass my service off to the next doc and have half the day on the wards discharging patients, and the rest of the day reserved for admin (finish any dictations, etc). It's been a pretty fascinating week. My last week here will be in the ER which promises to be equally crazy, I'm sure.
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