Monday, October 16, 2006

NewTube

Lest you think I am completely severed from the rest of the world, I present to you YouTube! Okay, so it took a free newspaper at work and the sales price of 1.65 Billion Dollars to join the throngs of net savvy folk out there, but here I am. Check this place out. I watched two episodes of The Office, the OK Go video, and an fantastic acoustic cover of Outkast's Hey Ya last night. Awesome...just awesome. Totally worth the money.

Saturday, October 14, 2006

Black Cloud

I am the Angel of Death. Or so it seems. One week, three call nights, and three deaths. A victim of unfortunate timing, I know, but the ghosts (figuratively, not literally) haunt me. I don’t mean to take this kind of thing lightly, but a grim humor is often the only way to deal with this type of thing. It is a part of my job. To help people live well, and to allow people to die in a dignified manner.

I never knew my first ICU patient. She was a tangle of tubes and lines from the day we met. She managed to transition from talking to her dialysis nurse to seizing and cerebral herniation in a matter of minutes. I cared for what was left. She had no brain function, her breathing was supported by ventilators and her heart was supported by pharmaceuticals. When the decision was made to remove support, I had to write the order. As I walked the long hallway to her room, I passed the community she was leaving behind. I shook her father’s hand (a parent should never live to see their child die, no matter what age) and wrote the instructions.

Doctor / executioner / angel of mercy / angel of death. She was much more comfortable appearing without our apparatus. She lasted maybe thirty minutes.

I have spoken of death this week more than I care to recall. I seem to be good at it. Not a talent I asked for, but we take what we’re given.

My Alaskan Family

Monday, October 09, 2006

One of us, one of us...

Check out the new guest book. If you a have couple seconds, sign in, so I know who is stopping by. Thanks, The Managment.

Night Float IV - the Final Chapter (Seriously, this all happened the same shift)

Where was I? Ah, yes, when we last left our young protagonist, he was flying high over the dark tundra of the far north. His patient gradually awakening from the narcotic haze of the vicodin. Vicodin, as you may know is hydrocodone and acetaminophen (Tylenol). Most folks worry about the narcotic. We worry about the Tylenol component. If you want a sure way to kill yourself slowly, Tylenol is the way to go. It insidiously cooks your liver, while you’re walking and talking. Our young man, fortunately, lived to see another day, another school year, and probably another girlfriend (hopefully he won’t make the same mistake for her) without any serious repercussions.

When I arrived back at the hospital, despite the late hour, my day was far from over. A 35 year old woman, with a history of large babies (often a complication of gestational diabetes), who was Group B Strep positive (an infection found in pregnancy that can cause meningitis in the newborn), and who was pre-eclamptic (one of the scariest of pregnancy maladies…hypertension, and protein spillage in the urine, leading to seizures) showed up with contractions 3 minutes apart. These three complications are scary one at a time, but here on the Delta, it’s all in a day’s work.

She was stable, dilated to two centimeters (three is considered active labor) and didn’t need antibiotics for her GBS status yet. It was just before 6 a.m. and I would let my Attending sleep a little longer before I woke him with a delivery that was sure to happen hours later. Move ahead forty-five minutes. Yes, ¾ of an hour. She is dilated to 10 centimeters, contractions are coming fast. We’re having a baby, whether we like it or not. (That is one of the nice things about OB. If you leave well enough alone, everything comes out in the end.)

The confused look on his sleepy face matched the ghostly, explicative deleted, pallor of my own, as I awoke him for the delivery. Amazingly the delivery went off without a hitch. It’s all good.

This is the Delta. Thank God. This is the Delta.



PS- Congrats to Tony and Lisa, and welcome to little Zachary. You guys rock.

Thursday, October 05, 2006

Night Float III

The flight to Chevak was dark. Dark like the inside of a cow. The black night was punctuated only by dark clouds. I was in a fish bowl looking into the living room at night. Nothing could be seen out those black windows. It could get none more black. Okay, point made.
When we arrived in Chevak, we buzzed the village, as our VHF radio wasn’t working. Someone flipped the switch and we saw the faint outline of the new runway, with its shiny new lights. We were to be the first to attempt a nighttime landing. How lucky could we get. Three tries it took, as we lost the runway on approach each time. The final loop we screamed in, hitting hard on the clay runway.

As our ATV slowly rolled through town, with mud silently coating our pants, our coats, our faces, and our gear, small batches of kids, young kids, drifted through the 2 a.m. fog. I had no idea a village this small could have so many young children, and what were they all doing up this late?
We walked into the clinic and a young man was snoring hard on the stretcher in a room created by a linen screen. Groggy, but arousable, we were told that he took an unknown amount of vicodin. A common story, boy comes of age, boy leaves village for college, girlfriend will be left behind in village, boy gets sad and takes prescription medications. He had several friends there with him. He is a good guy, they say. He doesn’t drink, he doesn’t do drugs, he doesn’t even smoke weed. A role model to everyone. He is going to leave and do big things.

As he wakes up, indeed, he is a nice guy. Literate, pleasant, sad that he has disappointed everyone. We put him in our stretcher, the trailer with a bent axel towed behind our 4 wheeler, and slowly head back toward the run way. The small packs of children again materialize out of the fog. They chase us as far as they can. Reaching out to shake his hand, to wish him luck, to tell him they love him. As we get closer to the runway, the children dissipate back into the fog. And the night is quiet, save for the sputtering of our ATV and the mud pattering off my jacket.
We arrive back in Bethel. It is 4 a.m. Surely dawn and rest are near.

Sunday, October 01, 2006

Night Float II

Sorry for the delay. I have returned to Anchorage, but will finish up the stories of my stay in Bethel for all who are interested.

9 p.m.
Blood in sputum, possible tuberculosis reactivation. Always a good start to an admission. Oddly enough, Alaska has one of the highest rates of TB in the nation. This is likely due to its prevalence in the native villages, and its propensity to be spread in close quarters. Many of my patients have 10-15 people living in their small homes. Our patient, a 48 year old woman came in, coughing up a fair amount of bright red blood. For some reason this is almost always disconcerting. There had been a recent reactivation in her village, and we were afraid she was an extension of that reactivation. To complicate things, she had a history of kidney failure and was on peritoneal dialysis. (This is an alternative to hemodialysis where the patient is hooked up to a machine that cleans their blood. In peritoneal dialysis, the patient simply hooks a back of a specially formulated IV solution to a port that goes directly into their abdomen and then drains it by gravity into a second bag.)

Haven’t had enough? The patient was also my first with Wegener’s Granulomatosis. A disease that affect the kidneys, lungs, and nasal passages with granulomas (a type of reaction usually to infection), causing dysfunction and bleeding. So, was she bleeding because she was infectious, having a flare of her Wegener’s, as a complication to her dialysis, or simply because she had a cold and coughed enough to injure the blood vessels in her lungs? Nice and easy question. I have to leave you hanging, because we didn’t get the sputum cultures back before I left. I believe it was either the cold or the Wegener’s. I haven’t converted to a positive TB test yet.

Was the night over? No. A young man in Chevak had just overdosed on Vicodin. I prepared for the Medivac flight without delay.