While on another day of call in the ED, I got a call from a village by the health aids about a patient who had a miscarriage and now was bleeding out quickly. She had retained products of conception and needed to have them removed. STAT. I would normally do an ultrasound and a procedure to remove the rest of the miscarriage, but she was out in the village where such a procedure would not be available, and the weather was too bad for any medevac to fly out. So over telemedicine (a video conference), I worked with the health aids to give her medicine to try to have her uterus expel the rest of the products. That didn’t work, so we were trying to find the right instruments to look to see if we could remove any tissue that was causing the bleeding. That didn’t work either, and she was bleeding too much for them to even see very well. I was so nervous and a bit sick to my stomach. I talked with the doctor on call here and the OB/Gyne doctor on call, and we were doing everything we could with the resources we had. As the health aids were slowly able to remove some of the tissue, the weather cleared a bit, and the plane was able to go to the village. Fortunately, the patient also had slowed down in her bleeding.
It was amazing working with the health aids over telemedicine, and a very new experience, teaching them by explanation, without being able to actually do anything hands-on or show them in person. We lost the actual monitor image for a while, so it was like me trying to guide a team in the dark. It reminded me of the game where you try to get people to draw or do what you are explaining with just words for instructions, and it was difficult to know what was going on. It made a world of difference to see via the webcam!
It is scary being a health aid out in the middle of the village where you don’t have access to imaging, tools, procedures and sometimes not even transportation, while a life-threatening emergency is in your hands. My hat goes off to the village health aids who are courageous and strong, providing such an amazing service to their communities.
Finally the woman came in and I got to do the procedure to remove the tissue (D&C, dilatation and curettage) with another doctor. I’m so glad I did an extra rotation to learn how to do these in residency. It is literally saving a patient’s life. And that is a super rewarding, amazing feeling than knowing that you helped somebody, especially out in the middle of nowhere, where they otherwise may have nothing else.
In addition to that case, it was a busy day! I inherited five patients to round on (as the hospitalist) starting out on my call day with the normal ED patients, including one of the most severe alcohol withdrawal cases I’ve ever seen, who has been previously medevaced for seizures and delirium tremens, and required intubation. And about 12 village calls. 4 of them required medevacs—one was appendicitis, direct to Anchorage. One was a boy with a post-operative infection of a broken arm with a pin in it. Another was the lady from the above story, another was in severe pain after surgery for an ectopic pregnancy. We also sent an appendicitis down to Anchorage from the hospital. It just seemed so busy all day!