Three critical patients and two planes


By now I really should know

If a morning is starting out slow

     I won’t get a break

     To finish my steak

Working nine hours in a row.

Euphoria opened my morning.

My stack of lab results started with a hypothyroid, a hyperthyroid, and a testosterone deficiency.

The thyroid gland is mainspring of the time clock at the plant: it tells the whole show how fast to run.  Thus most hyperthyroid patients can’t sleep, can’t tolerate heat, and lose weight.  Hypothyroid patients may gain or lose weight, but they can’t stand cold and they can’t get going in the morning.  Both conditions lead to lack of energy.

Thyroid problems are very gratifying to treat; I get to save the patient’s life for pennies a day and make him or her feel better.

Testosterone deficiency is much more expensive to treat, but the patient always feels better.

Morning walk-in and emergency clinic was slow and enjoyable but I was the only doc there.

A call from an outlying village elicited my advice to send the patient by commercial plane to Barrow but the patient didn’t arrive till after six.

I got to go to lunch early but I was called back to an emergency just as I was sitting down.  I bolted part of my lunch and threw the rest away. 

The afternoon waxed progressively frantic.  

In Barrow as in Sioux City infidelity leads to divorce, and divorce leads to health problems rippling through the family.  People come to me with ailments, and I can prescribe things like amoxicillin and hot soaks, nicotine and alcohol cessation.  To ease the real pain all I have are the ability to listen and words of wisdom. 

At quarter to six I realized that if I didn’t get to the cafeteria I’d miss supper and I was already ravenous.  I scurried down the hall and grabbed a Styrofoam box with what would have been a decent steak.  I bolted the cookies on the way back to ER.  Over the next three hours I managed to whittle away half the steak, a third of the potato, and all the vegetables.

I dealt with three life threatening situations at the same time.  A patient in town had developed a sudden compromise of a major organ system.  The patient from the outlying village had arrived with alarming physical findings.  A different village called in with information about a potentially salvageable patient. 

With three patients to transport and two planes I had to prioritize.  The in-town patient ranked highest; the outlying patient whom I had never seen got a plane directly to Anchorage.

I called Alaska Native Medical Center (ANMC) about the patient who had flown in at six.  The proper doc on call dialogued with me; with the recommended whomping dose of steroids the patient improved enough to keep in Barrow for the night.

Each Medevac transport south costs between $30,000 and $80,000 and as a result involves a number of hoops that must be jumped through. 

Two of my colleagues came through while I jumped through hoops and organized data; one because of call and one to be supportive.  The cozy outpatient area hummed with activity: two Medevac transporters, three docs, three nurses, a pharmacist, an X-ray tech, two patients with a total of six relatives, and a medical records tech.

I got back to the apartment at nine, put the steak fragment in the fridge and got out my saxophone.  I worked thirteen hours, the last nine without a break.

What had started off slow and clear and solo finished frantic and ambiguous and supported.

Contrast is still  the essence of meaning.

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