Another on-call day! I came in early to round on my patients, before starting the day.
The morning was fairly quiet, but then it started getting busy by the afternoon. A village health aide called and staffed patients with abdominal pain, jaundice, psych patient—two of them ended up getting flown in.
Another village (Little Diomede), the island right on the International Date Line, and is just across the border from Russia–called in to report a death. I have never done a death certificate long distance before, or when I had no idea about the patient. It took a while to learn what to do, and it took a while because most of the time I could not get a hold of people in Little Diomede to get the pertinent information. It’s tricky because an island like LD is supposed to comply with “national standards” of reporting to a medical examiner and the organ donation people, when in reality, they are an island of rock in the middle of the Bering Sea. They “bury” their dead by placing the bodies up on the ridge. Actually many villages around here do the same thing–because the ground is either too hard/rocky or too frozen throughout the year. Even here in Nome, during the winter when the ground is too hard, they put all the bodies in a house outside of town, then take them out to the burial grounds!
And another village called in a pediatric patient with Von Willebrands (a disorder that causes him to bleed profusely) who had hit his head and had a mild concussion and a concern for bleeding into his brain. I had him transferred here to Nome, and I talked with Pediatrics and Hematology/Oncology in Anchorage.
I admitted the most adorable pediatric patient for fever of unknown origin, nausea/vomiting, constipation, who we needed to put a feeding tube in to get him medication for constipation. He has had many various past medical problems, and it makes me wonder if something is going on. I also discussed his case with the Pediatrician, as well. Hopefully in time, the issue will declare itself and can be easily treated, because right now, neither I, nor any of the doctors are sure what exactly he has.
I had more calls and a circumcision to do (which the mom later decided not to do), but the end of the day came quickly, and the night on-call doctor helped me out to get some of the smaller things done, since I was leaving late. I feel tired, and I am still on the steepest part of the learning curve!
And I had a great ending to my day—there is a Nurse Practitioner student staying with me for a few days, and we had a really refreshing conversation about serving in underserved areas and being passionate about this kind of work, and how lucky we are to have been so blessed. because we don’t choose what we are born into, and it’s the least we can do to love and care about those around us.
Rounding inpatient (4):
ED 5 (3 admissions):
3 Peds (all admitted)
1 Bleeding disorder
1 fever of unknown origin
1 Abdominal pain
Deaths (where I signed the death certificate, did not provide care for pt): 1