Deep Calming Breaths

Nope. The first day wasn't the craziest after all. I knew today was going to be downright unpleasant when, while still in my cold weather gear (see pics - both inside and out, prior to tying my sweater around my face bandit-style), the night float doc accosted me and my fellow wards doc and said, "there a patient having a stroke, unresponsive currently, and a patient about to deliver in the village. Someone needs to get on the medevac to deliver her." It's always interesting what you can find to rock paper scissors for around here. I quickly weighed my fear of flying in small aircrafts in the Alaskan winter against my fear of neurology. About equal. Unfortunately, though, it was my patient having the stroke, so sticking around to help work that out seemed like the prudent thing to do. My partner immediately headed to the ER to be whisked away to a remote village delivery.

The rules of medevacing to a delivery are complicated. If the patient initiated prenatal care at the village clinic or in Bethel, but she decides not to come to Bethel by her assigned "Be In Bethel" date (36 wks), the policy is that she must have a delivery in the village with no medevac and no doctor. However, if the patient has no prenatal care at all, a family doc and pediatrician must medevac to the village for fear of a premature delivery (since we do not have any ultrasounds or clues to gestational age). This patient today did have a large belly measuring at about 38 weeks, which was reassuring, but still the medevac must go. Mom and baby did fine, and were transferred to Bethel after delivery. Once in the hospital, though, the baby has to be isolated from all the other newborns (who were all born in the "sterile" hospital environment) and is referred to as a "dirty baby." I just hope the title doesn't scar it for life.

Meanwhile, my "stroke" patient ended up (thankfully) to be having a hypoglycemic crisis and perked up well after a head CT (normal) and some glucose. When I went to check on him just 15 min after getting the report on his events, he was sitting up in bed eating tater tots and an egg and cheese croissant (diabetic diet!?!?!). Whew.

One bullet dodged. But they just kept on firing. I had about 45 RMT calls, a steady stream that turned into a deluge in the late afternoon when I was (of course) about to deliver a patient (18 year old G1P0, pushed out a 9 pounder without issue). The calls covered the spectrum of not scary (wound checks, common cold), moderately scary (13 year old threatening to hang herself - never to be taken lightly but especially here where 13 year olds hang themselves with alarming frequency), to downright shake in my Sorel boots scary (62 year old previously healthy woman found down by boyfriend, barely palpable pulse, breathing 40 respirations per minute, minimally responsive).

That call (which came during my 7 min lunch break) was from a health aide that was called to come to the patient's house. She had no equipment on her to take vitals or give oxygen. I activated the medevac and had another health aide come from the clinic with any supplies she could bring. About 15 min later I got an update that the patient's heart rate was 130, resp rate 40, oxygen saturation a whopping 55%, and a temp of 94 degrees F. The health aide was unable to get a blood pressure. Yikes. I had them try place and IV for fluids (very difficult in her cold clammy extremities) while we waited for the medics.

I heard that she made it to our ER alive, was on pressors, and hadn't needed to be intubated in the field. She'll be sent off to Anchorage once she is stable to occupy the ICU there for awhile.

Shortly after that, I had to reactivate the medevac to get a 98 year old woman having a stroke in a village. And I heard my wards partner say that earlier that day she had the medevac getting someone else. That makes 4 medevac trips in 10 hours (counting the morning village delivery). Is that some sort of record?

On top of that all, I had the usual wards business to deal with: multiple discharges, admitting a floridly psychotic 18 year old having his first psychotic break, removing the chest tube of a different 18 year old patient with a spontaneous pneumothorax (which seemed benign enough - he was much improved and I was instructed to pull the tube by the surgeons... but somehow he got worse after I pulled it).

It was a lot of action for one 10 hour shift. AND last night I loaned my pager to the nigh float doc (who didn't have one yet). Tonight he has his own pager but somehow I'm still getting his pages. I will lose it if I get mistakenly paged all night long.

I am taking deep calming breaths now... thinking zen thoughts of my upcoming Hawaiian vacation that will be funded by this arctic adventure. Deep calming breaths...