Location of Locum Assignment(s)
Cindy S. has been gracious enough to share some of her stories and experiences of being one of our locum tenens providers in Alaska. She sends these stories to her 94-year-old mother, who then goes on to share them with friends and family. The following is a slightly abridged version of one of the stories she’s written and passed along to the WMS team. This story is a wonderful example of what it’s like to have limited resources in a remote and austere environment while performing life-saving measures.
“My day started out with a phone call from the company CEO with all kinds of kudos for yesterday. Yesterday started with a bang. I went down the steps from the apartment and the guy who lives in the house across the boardwalk motioned me inside. I met him at the door and he told me I had to go inside his living room so he could talk with me. I’m not sure why, but anyway, I did. Three breaths in there must be equal to 2 whole packs of cigarettes. He had started feeling dizzy, having trouble breathing, and had chest pain. He didn’t think he could walk to the clinic which was only a couple hundred yards away. I told him I would get someone to bring him.
We have a VPSO (Village Public Safety Officer) who has an office directly across from the clinic and one of the things he will do is act as a taxi service, when needed, to take patients to and from the clinic. He brought the man in and I knew he was a long-time smoker with lung disease (not cancer), like emphysema. So, the first thing I did was get him started on a breathing treatment and that helped a little, but he was still not looking very good, was still having chest pain, and now also back pain. I listened to his lungs before and after and he seemed to be moving more air and had no more noises in his lungs.
While he was finishing that, I asked my health aide to get our new EKG machine and start putting stickers on him to run an EKG. Well, the reports didn’t look very good. There were some indications of heart attacks and he really had A-fib going. A-fib that isn’t too bad is usually controlled with medication. His, however, was really bad and causing the bottom part of the heart to beat way too fast, up into the 150s. This means that blood isn’t getting out and about to the body well, because it doesn’t take time to fill with blood from the top part before squeezing it out. Also, the whole thing isn’t coordinated, so it’s a matter of the left hand not knowing what the right hand is doing.
After I got these results, I called the ER doc at the nearest, larger medical center, which was 1300 miles away. I took a picture of the tracing and sent it up to her on my phone with a secure email system. She didn’t see many heart attack signs and went more for A-fib with a rapid ventricular response (that’s the bottom part beating too fast). In the meantime, I treated the guy as if it were a heart attack. The doctor called back in a couple of minutes after looking at the EKG and said I needed to shock him and get everything all coordinated again. I’d never done that, and it was a scary thing to do, so I called my newfound friend from another local medical clinic, said I needed her help, and why. She was there in about 5 minutes it seemed.
My new friend is a former army soldier with combat experience and is now a PA (and another WMS provider). She’s had a lot more real ER experience than me. So, I handed her the phone with the doctor and I started getting other stuff I knew we would need. My PA friend had an FNP friend who was an ICU nurse practitioner. So, there were 3 of us, plus my health aide who I assigned to do frequent vital signs.
We hooked the patient up to a machine called a LIFEPAK. It’s a portable machine that will do pulse, oxygen saturation, blood pressure, to single cardiac tracing, 12-lead EKGs, externally pace the heart, shock for fatal types of rhythms, and arrest. It will do nearly everything on battery power. So, I had fixed him up with the big pads to get him ready for shocking. That is one pad on each side of his chest. The jolt is relatively low compared to cardiac arrest power, but it will still set you right up. This is exactly what happened and he yelled out wondering what we were doing to him!? Fortunately, for everyone, his heart settled into a better rhythm, his pulse rate slowed way down (and so did ours), and his blood pressure came up.
We still had the breathing problem and were still giving him treatments. In the process, we had also taken a chest X-ray, which looked a little like he might have some pneumonia, but not definite. We had started a total of 3 IVs just in case he went “south” and we had to start medication drips. Each medication requires its own separate line. We had also done a metabolic panel, I couldn’t do a blood count. We also took his temperature which I hadn’t done earlier because of other pressing matters. It was now 99.1. We decided to start him on medication.
He also was feeling nauseated at times and we really didn’t want him throwing up as this could really complicate matters. I got anti-nausea pills out of our machine. We gave him one and this helped some. It was time to start antibiotics, as it seemed like he was developing pneumonia on top of everything else. We also gave him some steroids to help with his lung problem and an injection of medicine for his fever that would also help with the pain.
The PA had been on the phone trying to organize transport out while I tried to get the X-ray computers working. I could get our helicopter to take the patient out, but LifeMed was on a mandatory 6-hour rest with 5 hours of it left! So even if we got him to another town, there wasn’t anyone to come and get him. So, sometime in there my PA friend, called her company (where she worked at an on-site health facility for a food supplier) and gave them the whole, long, sad story of what was going on, and the frustrations we were experiencing. The company authorized and called in a boat that was an hour out to come and pick up the patient and take him to where LifeMed is stationed. My friend made these arrangements, and then all of a sudden everyone was leaving, patient and all, and I really didn’t know what was going on. I knew about the boat but had no idea it was going to be so soon. So, I started out walking to the plant with my backpack because I had decided I should accompany a patient this sick.
It was about 5 and a half hours to our destination. During the trip, I needed to make a couple of phone calls and the captain loaned me his satellite phone. I called the ER doc and updated her, I called my medical director to fill her in on what I was doing and what was going on.
When we arrived, the ambulance was there, so we loaded up the patient in the back and drove to the airport. It took a few more minutes for the LifeMed crew to arrive. We got him and his brother into the plane and on their way to the larger health facility. I went back to the boat and used the phone to tell everyone I was on my way back.
So, all this brings me back to the CEO’s congratulatory phone call this morning. I told him it wasn’t a solo operation; I had help. I also asked him if he would consider writing a thank you letter to the captain of the boat and their company for their assistance and he said he would.”