I got to do 3 calls from Wed, Sat, Sun, one was a double or two 12s in a row…ie 24 hours. It feels like not-so-long-ago in residency! We had really amazing medical cases. On wednesday, we had Pediatrics (I admitted a kid with a concussion and vomiting), Internal medicine, Pulmonology (admitted an elderly man with end-stage COPD), Psychiatry, OB/Gyne–I delivered a baby (and it was such a great delivery–Yay!), and had an elderly lady with chest pain and high heart enzymes, but it turned out to be influenza pneumonia that strained her heart and looked like a heart attack. (whewsh!) If you have ever read “The House of God” this patient is a Gomer, and the first rule of the House of God is that “Gomer’s don’t die.” 🙂
On the weekend, I had Orthopedics, Pediatrics, Psychiatry, Internal Medicine, Neurology, Plastics (sent to Anchorage for a terrible dog bite to the face)–I almost tried to stitch her up, but then realized that the bite was through her entire side of her face, from her lower eyelid to her mouth, and the facial nerve and face muscle were all involved. 🙁 We had lots of village calls with super interesting medicine. I admire the health aids so much for all that they do!
We had a very complicated Cardiology case with a very young male in his 30s, who had severe chest pain, sweating, and a clear myocardial infarction (heart attack). I have not yet had a heart attack where Cardiology is not readily available to take the patient to do a cardiac catheter to reopen the closed heart arteries. So I went through the protocol–gave him all the life saving medicines we have, and then I gave him a thrombolytic (clot breaker) dangerous medicine to break open the clots. The very risky thing about this medicine is that it thins your blood and prevents it from making clots, so patients can easily bleed out. I have never been the one in charge of giving this medicine before, and I was terrified to do it. Of course I gave it to him under the guidance of the Cardiologist.
The ER nurses and pharmacist were awesome, and they gave him medicines in a very timely manner (which saved his heart!), we had a hard time getting a hold of the airline that does our medevacs, and other time-delaying factors. When getting ready to take off, the flight nurse called me and told me the patient had left-sided facial droop and slurred speech–symptoms of a stroke.
There are two ways to have a stroke (a stroke is having the blood supply from an artery cut off): one is to have a clot that blocks the artery, and one is where the artery bleeds out, so the blood supply downstream is lost. I was sure that he had bled out into his brain from the medicine that we gave him.
All I could say was “Just get him to Anchorage…there is nothing more we can do here.” However, the flight nurse said by the time he got to Anchorage, he looked much better, and everyone on that end wondered what we were so worried about (that is always a relief! Better that we err on the side of caution and have a good outcome than the flip side).
I just called down to the Cardiologist in Anchorage to review the case and make sure we did everything appropriately on this end. He said we did, and then he told me he did not have a bleeding stroke, but a thrombotic (clot) stroke. Which the treatment for that kind of stroke is also the blood thinner/clot buster medication that we gave. Saving hearts, saving lives. <3