Sushi and Bowling, Saturday night!

Ahhh! I got a long night of sleep. I kept waking up and checking my phone, just to make sure I didn’t miss a call to come in. But there was none. (none that came through, at least). I had a lazy day of kind of studying and working on things…in my comfy bed. :)

But then got an invitation by friends to go out downtown for sushi and bowling! I find it hard to believe that a Saturday night in Nome can be so full of entertainment! Just like a big city. 😉 I went out with my roomie and a few friends to Milano’s Pizzeria/Korean/ Japanese/Italian/sushi. I’ve never seen such a diverse restaurant in my life!

Milano's Italian      Milano's sushi

Milano's Korean Japanese

Milano's pizzeria

Then we went bowling!!! Surprisingly there is actually a bowling alley in Nome. And it is run by the same man who helps us arrange travel for patients to the villages. He is awesome. He loves to be able to help people in his community, and he is trying to give the youth here a positive, healthy place to hang out.

Bowling!

The Bowling Crew

 

bowling score keeping

Learning how to keep score.

happy score-keepers

The happy score keepers. :D

Then when I got home, I received another text message about another party! It’s probably too late, but still… I’m impressed by this place!

Then watched a fun French Rom Com (Romantics Anonymous) with the roomie before bed.

It was not a very productive day from a to-do list standpoint, but it was very refreshing!

 

Call again!

On call again! I got 8 hours of sleep last night! I feel like a new person. :) Call was busy today, and I can’t even remember a lot of the cases that came in.  But I know the medevac teams were out all day with 4 medevacs—the same guys I went with yesterday, went out on three medevacs today. I hope they get some sleep!

The most important learning part of my day was right at the end of my shift, a medevac came in from a village with an ATV rollover accident (ATVs are the vehicle of choice in all the villages), and I got to stay and watch the very experienced doctor, who has been in the military, do the trauma exam/work up. I learned about all this in the ATLS (Advanced Trauma Life Support) course, and a little in residency (not enough!) but most of it is theoretical knowledge that I haven’t yet put to use. It was really great to have the opportunity to see his routine. Luckily we have a CT and could diagnose a fracture of his cervical spine that needed to be sent to Anchorage. I stayed later for this experience, which is so worth it for the education. Then the ED got super busy. It’s a pretty full moon (not that I’m superstitious or anything) and the month that the PFD (Permanent Fund Dividend) gets distributed, so lots of people do lots of crazy things with their extra money, often under the influence of alcohol. It breaks my heart to see how much it affects peoples lives here.

Since it was busy, I stayed to see another patient and offered to stay and see more patients. But the doctor who was so calm and took everything in stride, and didn’t need help. He is excellent at triaging patients and getting patients in and out quickly. I hope I get to that level of doctoring some day. :)

Amazingly, I didn’t have any admissions–so I’m excited to sleep in on my Saturday off! (providing no medevacs or deliveries). Here’s to not setting an alarm clock!

My First Medevac!!!!

I got a call around 2:30 this morning to come in for a medevac. It was for preterm labor in an outlying village. I got up, gathered my things, drove to the hospital. Checked again with the doctors to make sure it’s ok that I go on the medevac. And again it strikes me, *I am it; I am the doctor now.* (!!!!) We gathered the medical kits from the hospital, and then the paramedics got their life-saving equipment from the airport. The team was made of two flight paramedics, an OB nurse, me and the pilot. We flew out to the village in the dark on the King Air.

King air medevac

The King Air, after sunrise in Anchorage

 

There was a full moon out, that we could occasionally see through the clouds, reflecting on the Bering Sea, so beautiful! It occurred to me that I’ve never flown in small plane in the dark before. Only in the day, or big jets at night. I started feeling a little nauseated, but the paramedic gave some alcohol swabs to sniff, and it worked!

We arrived at the village around 4:30, and the pt was still have faint (but diminished) signs of preterm labor. Even though I didn’t think she was really in active labor, after talking about it with my colleagues who have been here heaps longer, we decided that instead of going to Nome, it would be best to go to Anchorage. Since we can’t do much for pre-term labor in Nome. Plus there was a recent preterm delivery where the baby wasn’t doing well, so we are extra erring on the side of caution. It’s really, really good for me to learn these things.

I had some great conversations with the awesome paramedics. One of them has been working here for 30 years, and he and his wife also went to Papua New Guinea!!! Out to New Ireland. I love the people here! :)

We got to Anchorage ~ 2 hours later, into a strong headwind that made for some turbulent skies! It was lovely to see the daybreaking over Anchorage. We landed and then got picked up by ambulance, which took the patient and us to the hospital. If I thought the hospital in Nome was kind of a museum, Anchorage Native Medical Center (ANMC) really is a museum!

Mural:

ANMC mural

They had hundreds of dolls and figures featuring native dress from all over the state of Alaska:dancer

Waterproof bags made from stomach and bladder and heart-lining:waterproof bags



Fish skin baskets: fish skin basket

ccc

 

We then got to go eat breakfast and do a few errands around town. If there is time, it is nice for the team to be able to pick up a few things while in Anchorage (ie. Donuts and McDonalds for the crews back home, and cheaper fruits/veggies and flowers).

Then we were off again. This time, because my stomach was still feeling queasy (I’m such a wuss! :)), I got to sit in the front! medevac with an awesome pilot, who has been flying here for 15 years, and has been a pilot for 22 years. It was so much fun to talk with him and hear his stories. He has a little plane that he takes his family out to cool camping spots and the hot springs around here. He pointed out the active volcano, Mt Redoubt, that blew off ash a few years ago. WE got back to Nome, and I went straight to radio traffic. Since I had gone in at 6:30 yesterday am (for the delivery), and I had been home ~ 4 hours before being called in for this one, I was tired! early night tonight!

Hump day!

I got to do another delivery this morning (yay!). I think, though, that the OB cases are progressively getting more complex and more difficult to manage, which is really good for expanding my experience. Today we had a baby that was sunny side up (ie. looking up at the ceiling), which makes it really difficult for the baby to come out. Then the baby was having a lower heart rate during contractions (which made us all more on-guard…well, is quite frankly nerve-wracking). Then after delivery, everything turned out well and looked great, but then we had another post-partum hemorrhage. :/ I did get to use my ALSO (Advanced Life Support in Obstetrics) training ~ twice. One for doing a manual rotation, to turn the baby to come out looking down at the floor, rather than up, which makes it a lot easier to deliver the baby, if it works. And two, to manage the post-partum hemorrhage.

I keep realizing things that are a change of mindset for me: for example, we don’t do any epidurals here. I forget to use some of the easier, less-interventional techniques that we can do with mamas who are delivering naturally. Like today, maybe instead of doing a manual rotation, having the patient get on hands and knees to gently help turn baby around. We did have her lay on her side, which in combination with the rotation, the baby turned. But for a woman without an epidural, a manual rotation is lots more uncomfortable, and it makes people yell in pain…which in turn, makes me want to just stop and ease the pain.

Obstetrics is hard, because in the moment when it looks like the baby is in distress, you want to do everything to get the baby to be ok. So today when the heart rate was dropping (and for a while it was difficult to find, and I thought there wasn’t any), my first thought was we need to get the baby out, (and I’ve seen lots of manual rotations work wonders for helping a baby that is sunny-side-up deliver quickly). But then again, maybe things would be fine if you take a step back and wait a moment and let things happen naturally. It seems true that based on lots of worldwide studies that we don’t need to be as interventional as we are. And I love home births and I really loved the documentary “The Business of Being Born,” and I want to be more natural in my approach to delivering babies. But then I also reflect back on med school, to our Pediatric rotation, when we got visit with a family who had kids with medical problems, and my assigned family had a son with Cerebral Palsy, who was bright and full of joy, but who couldn’t speak and had severe disabilities, and the mom telling me her story of how it did not seem like the doctors did the right thing during her delivery, and it felt like it was their “fault” for not acting fast enough. Then I get scared of something like that happening, because I didn’t do the “Right” thing. Is there a right or a wrong thing in OB? Studies tell us that we do too much–too many c-sections, too much augmentation of labor, too many interventions during their labor. But case studies of things that go wrong yell louder at us that we have to do more, sooner, quicker. And at the end of the day, we all want a healthy, happy baby and a healthy, happy mom. What is the right answer?

I have much to learn… It makes me feel like I want to run right back to training. I don’t feel ready to be on my own. I want to see how more OBs deal with this type of situation (even though I’ve seen plenty, and the most interesting thing is that they all deal with it differently). and I want to go through OB residency training, and midwifery training. And I want to shadow people who have done it much longer than I have.

I talked to the visiting OB/Gyne specialist about this today, and she agreed~ that when you are first out practicing, like a fledgeling learning to fly, there is nothing so scary as taking those first solo flights. No matter what happens.