June 15, 2006
Living and Working in Western Alaska
K. Jane McClure MD
It was another Tuesday on the wards. I had just surveyed my patients when my pager went off. A woman was in labor at 30 weeks on the coast and I had half an hour until the Medevac.
I hurried to triage my inpatients. My new admission was a 6-week old boy admitted with “gastroenteritis.” He’d been well until three days ago, when he began vomiting, at first infrequently, then with every feed. Last night the patient returned to the ER because he was getting sleepier. I reviewed the labs from the ER and ordered NG decompression, IV fluids and a pyloric ultrasound before signing out to my colleagues and hopping on the ambulance to the airport.
It was 10 degrees below zero out, and the eight-seater plane was cold as we loaded in our supplies and headed 100 miles to a village on the coast. The patient’s contractions initially slowed with IV fluids and terbutaline, but on exam the family practitioner found the mom to be dilated to 9 cm with a bulging bag.
The baby was estimated to be 30 weeks by uncertain dates and an 18-week Ultrasound.
We heated the second exam room in the tiny clinic with a portable heater to 100 degrees, and heated bags of IV fluid to lay beside the infant. The baby came out vigorous but soon developed retractions and was intubated. I started a UVC line and fluids, drew cultures and labs, and prepared her for transport to Bethel.
The village clinic was on the opposite side of town from the airstrip, and our transportation was a dogsled pulled by snowmobile. We loaded the incubator on the sled, hand-bagging the baby as we traveled.
We headed back to Bethel to meet the Anchorage neonatal medevac team. My 6-week-old with pyloric stenosis was able to join our 30 weeker on her trip to Anchorage where he had surgery that night.