Back in the hospital this morning at 6:30 am! Glad I slept in yesterday long enough to cover the whole weekend. 😉 It was busy when I got there this morning, the ED providers were in the middle of medevac(k)ing a patient to Anchorage for a chest tube that was leaking air under the patients skin, and it wasn’t able to be easily stopped. This particular diagnosis is kind of tricky to medevac, because with the change in pressure, air can more easily get under the skin, so the plane has to fly at “Sea level” (ie a pressurized cabin to sea level–not actually just above the ground, which is what I first thought it meant). Just before this one (and just before I arrived), there was another medevac out. So that meant we were down two flight teams, and if we needed to medevac anyone else, we would have to scrounge to find people on their day off to become flight crew. *cross fingers*
There are two different ways to send patients to Anchorage–one is for emergent cases, where we MedEvac by airplanes chartered through the Bering Air aviation company. They always reserve planes for patients, and they do their best to have enough resources at all times in case of emergency. This means sometimes they cancel some of their other chartered flights. The second is by commercial flights–usually Alaska Airlines. These are both paid by the native health insurance for the patients (and if needed, their escorts). Luckily we didn’t have any more emergent flights today, and the flight crews got to sleep (they were busy with medevacs yesterday too!)
Then I had another pregnant patient come in active labor (yay!), and I got to deliver another baby! 😀 It was a more difficult case with post-partum hemorrhage, and I got to use my newly-acquired Advanced Life Support for Obstetrics (ALSO) knowledge (from the course I took this summer). It is so weird beign the one in charge, making decisions. I just didn’t ever have that “I am the one to make this call” in OB training in residency. I’ve gotten to deliver over 100 babies and have seen a few post-partum hemorrhages, but we were always with other doctors who were more experienced, and who would help or take over as soon with anything complicated. Now it is me! I know I mentioned it before, but it struck me again today. (I wonder how many times it will strike before it becomes natural and sinks in?). I’m glad that I’m still new and I still have a backup physician to help out! We had another pregnant patient with a similar complication as the one yesterday, who will go by commercial flight to Anchorage.
2 OB pts, 1 delivery
1 subcutaneous crepitus, after chest tube placement for a collapsed lung, medevac
1 PICC (peripheral inserted central catheter) line that was coming out and needs to be sent to Anchorage on a commercial flight.
1 infected finger, pediatric patient
1 Submandibular abscess
Luckily there are amazing PAs who work here who see the bulk of the urgent care patients in the ED, since I was gone for a while in the delivery)!
Highlight: Tonight I just noticed how big my plant has gotten! (the one that Sarah gave me as a welcome gift when I first arrived):
Grow and bloom little plant! My reminder to flourish where I am planted…
I have a day off tomorrow (besides rounding on my mom-baby pair)! I’m super stoked, because it’s also a week day, so I can get things done!