Strides

As my week draws to a close here I'm finally starting to hit my stride. I suppose I should have expected it to take nearly a week to be reacquainted with medicine Bethel style.  I had a thoroughly and satisfyingly Bethel day yesterday with a medevac and a delivery all in the span of about a hour.

I had a few quiet moments to eat my lunch in the OB break room where I took a page from one of the villages.  The village health aide had been doing a follow home visit on a 76 year old man who had been seen the day before for cough.  She starts by telling me he's had a cough and congestion for a few days (blah blah) took some over the counter cold remedy (blah blah, munching on my lunch of beans and couscous), but now seems worse.

Me: Worse?  How so?
Health Aide: He's not acting like himself.
Me: How so?
Health Aide: He's been lying on the couch all day.
Me: Do you mean he doesn't want to get up off the couch, or that he is not alert enough to get off the couch? (insert slowly rising sensation of panic in the belly)
Health Aide: They can't wake him up. 
Me (wishing I had asked this 5 min before):  What are his vital signs?
Health Aide: Respiratory rate is 44 and oxygen level is 80%. And I can't get a blood pressure.

eeeeeeek! Sometimes I wish the health aide calls would start like this: This patient is really sick! Let me tell you all about him!  Instead of a calm retelling of many interesting but non-critical facts before catching me off guard with a doozy while lunching in the break room.

Needless to say I had to don my superhero cape quickly and activate the medevac (I love that phrase, though it does generally mean badness is imminent).  The patient was intubated immediately once the medics arrived (uh, you think??), and he was put on pressors for his blood pressure that they were able to record at about 50/30 (no wonder it was hard to get).  He was taken to Anchorage, where he's admitted now.

Then, while in the ER delivering the papers on the medevac patient en route, I got a page to come to OB triage for "patient to be evaluated, might be in labor".  This, in Bethel speak, means there is a term patient who says she is having contractions (though you'd never know it by her calm face or the easy way she walked on to the unit.  And now I have my own labor experience (insert many high pitched screams) to compare to.).

The patient is a 24 year old, third baby, who said she started feeling contractions earlier that morning, and they are much more intense now.  (searching her face for signs of pain or discomfort during a contraction - none)  I check her to find she is 6 cm.  It is 3 pm. We admit her to a labor room, get an IV started, and get some paper work done (this takes about 10-15 min).  She has a gaggle of women with her (one who is equally pregnant though not in labor).  The patient says quietly "I need to push".  If I have learned one thing in Bethel, it is not to pass go or collect anything when a laboring woman utters these words.  It's go time.  I tell her to hold off for a minute while we prepare the laboring tray.  About a minute later she says "Now I really want to push".  On go the blue sterile clothes and gloves in a flash, and out comes a screaming, pink baby girl in 1 - yes 1 - push.  Head, shoulders, knees and toes.  Out and onto mama's belly at 3:31 pm.

Now that is how to deliver a baby (and really, let's give credit where credit is due and say the mama really delivered that one.  I really didn't have much to do there at all!).  Almost makes me want to have another one myself.  If I could channel her energy, that is.