Christmas? Easy. The day after? Difficult transport


For ambulances, we have only two.

The blizzard came out of the blue

It stormed and it snowed

All the way down the road

That’s the reason that nobody flew.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. I spent the winter in Nome, Alaska, followed by assignments in rural Iowa. The summer and fall included a funeral, a bicycle tour in Michigan, cherry picking in Iowa, a medical conference in Denver, working Urgent Care in suburban Pennsylvania, and Thanksgiving in Virginia. Right now I’m in western Nebraska. Any patient information has been included with permission.

Christmas went quietly, and I only write that after the fact because I don’t want to jinx myself by saying good or bad when people ask me how the call is going. I always say, ask me when it’s over.

I used to work at a place which regarded the holiday as lasting 5 days, with me on the hook for 120 continuous hours. The second year I started with a census of 38 hospital patients  At the end, with a grand today of 20 hours of sleep, my work quality had degraded significantly in that I had quit caring.  The following year I absolutely refused to carry the beeper for more than 72 hours.  Management voiced their objections, which I noted, and used the phrase “patient safety” in my reply.

I don’t work there now.

So far here in Nebraska I haven’t worked more than 50 hours a week. When I go home, I go home.  The term “call” carries no meaning; I have no beeper and they expect me to turn my phone off at night.

I finished my Christmas work before noon, went to the gym, and got back home in time for lunch.

This morning, the day after Christmas, I went in to make hospital rounds and staff the Saturday clinic. I crept down icy asphalt, a strong north wind threatened to blow me off the road.  Just as I pulled into the parking lot snow started in earnest.

I can’t talk about individual patients but I can speak to the aggregate: all could remember the start of World War II, and all could remember the Armistice Day Blizzard of 1940.

One patient had improved enough for discharge.

The medical end of the discharge process came easier than the EMR. I ran into a 16 item set of blocks requiring responses.  I clicked in a couple of places, got no response, muttered in Navajo (the only per se taboo words have to do with the government), clicked again and nothing happened.  Eventually I asked for a consult from the ER doc.  By the time help arrived I figured out that my computer had locked up and needed restarting.

One patient, having failed to respond, required transport to Omaha, but the weather had worsened to blizzard conditions and no one would fly. The town has two ambulances, one had yet to return from a transport in the wee hours.  So my patient’s transfer would have to wait for a loaner from another community or the return of our other ambulance.

I looked outside at the whiteout, and I thought of Barrow, where weather prevented flying an average of 1 day out of 3, and the flight would last a minimum of 5 hours. The ground transport to Omaha would last a fraction of that, with several other hospitals along the way if the conditions worsened.

Saturday clinic welcomes walk-ins but has no appointments. I saw my first patient at 10:15AM.  I have gotten enough fluency with NextGen that the documentation flowed.  I took care of 5 out patients.  One had an alarming physical finding I’d never seen before.

At the end of clinic I bought delivery pizza for the skeleton crew. We usurped the conference room and chatted.  When I walked out, the snow had stopped but the wind, if anything, had freshened.

I didn’t have to scrape the windows.

 

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