Meet Tray N.
Location of Locum Assignment(s)
For those who are not familiar with Akutan, Alaska, like I was prior to this assignment, it is a small island in the Aleutians East Borough that has a population that averages around 1,000 people. This is my first assignment in Alaska and what I would like to share with you is the need to be self-sustaining and adaptable.
My third day here on the island, I was resting in my apartment between my clinic hours when I received a call saying there had been an accident in the plant and they are bringing the patient to the office. I grabbed my bag and mask and headed that way.
When I opened the door, I saw a young man holding his hand and blood running down his arm. I was told his hand was smashed when a metal door dropped over a grinder and he had to pull it out. When we unwrapped it, he had a partial amputation of one finger with multi areas of deformity and two other fingers with small lacerations. In a regular practice environment that would be straight to ortho/OR type of patient. Did I mention we are in the middle of nowhere?
The tricky part about this assignment is the islands generate their own weather pattern, so we have a very narrow window of time to fly anyone off this island to a neighboring island to then be medevaced by a King Air airplane. This happened during one of those no-flight/boat days. I was able to administer a block, irrigate and clean the wounds, explore for any open fractures, and loosely suture the wounds to control the bleeding.
We had a boat that would be in to transfer him the next morning at 0300 hours and start his 7-hour journey to anchorage. I was told that he was seen by the trauma/orthopedic surgeons that day and had his had repaired and is currently doing well.
This environment quickly changes your outlook on what your next move is in your patient care. You must be medically aware, weather aware and be ready to transition from ER to ICU to inpatient care quickly.