So there we were on a remote island, a couple of hours flight from Darwin. We had arrived on our own little charter plane, crossing a crescent of deep blue ocean onto a lushly wooded island. The clinic was practically closed as there was a death on the island the day before, and everything was in lock-down mode. It appeared as if we had fatefully chosen a bad day to come to the island (and we only visited three times a year!)
We spent most of the morning seeing just a handful of patients. As we were having a cup of tea and getting ready to pack up and call it a day, a nurse ran into the tea room and shouted "We need a doctor! Emergency!"
It was almost a little surreal, as the tearoom really felt like someone's lounge room, and it didn't seem like we could be called to attend an emergency in such a cosy relaxed place. But as we ran outside, reality sank in - there was a landcruiser with a handful of locals, shouting and gesturing frantically at the motionless figure sprawled across the backseat.
For a split second my brain froze as I thought it was the lady I had just seen in clinic, but as I got closer I realised it was someone else. She didn't appear to be moving at all. My boss started doing chest compressions and all of us together managed to get her onto the trolley to move her inside the clinic.
Inside we realised that she was in a terrible way, and that she was probably "gone" as convention would say. Her heart had gone into a seriously abnormal rhythm and was unlikely to recover. We carried on the resuscitation, knowing the grim prognosis at the back of our heads. We looked at one another sternly and decided on ten minutes as a cutoff point, thinking that everything would probably end there and then.
Ten minutes later we were surprised to find that she had started to show signs of life. So we kept going, and going, and eventually got to a point where we had to make a decision to evacuate her to Darwin. It was a bad day to fly - Darwin was a no-fly zone because Obama was in town, and we ourselves had even seen the giant US airforce planes parked across the runway at Darwin like alien spacecraft as we took off in the morning. Careflight took several hours to come, and things had taken a serious turn for the worse during that time, though she was still alive.
I have never been called upon to bag ventilate a patient for four hours. The repetitiveness of the muscle strain aside, my mind was adrift in a sea of thoughts, about what had happened during the resuscitation, about what would happen to the patient once she made it out of this place (or would she?), about all the things that we didn't have on hand at the clinic.. about all the ways things could have been better.
But there was nothing I could do, other than rhythmically squeeze that bag. It was almost hypnotic, watching the oxygen go in and out. Eventually when Careflight came it felt like there were so many people in the room it was almost like a circus. As we got ready to leave the clinic, I looked outside and it was completely dark. There were dozens of faces in the front yard peering anxiously inside the security fence, and beyond those faces were even more, spilling out onto the main road. We drove to the airport and there was a crowd there too, all lined up along the fence near the Careflight plane. It felt like half the community was there, and though everyone kept quiet, it felt like a potentially unrestful situation.
Later I heard that she passed away in intensive care, which was more or less the expected outcome. Though she'd fought the odds to come back, the time before she got to the clinic that her heart had not been working and the long time it took for her to be retrieved, meant that she didn't really have a chance at long term survival.
I had never done an out-of-hospital resuscitation before, and getting to grips with the difficulties of being in such a remote location was certainly an eye-opener. A lot of things we take for granted in the hospital setting simply do not exist out there, and we were having to "make do" with what we had. There was a lot of thinking on one's feet, and given the circumstances I thought everyone involved did extremely well. On one hand there was certainly the feel-good factor that even in the community there were competent doctors and nurses serving the community, but there was also the sombre undertone that this is the harsh reality of life - getting sick 1000km away from the nearest major hospital is tough, and it's really touch-and-go. And not every community is going to have such a wonderful clinic, though it really makes one appreciate the work that remote health workers do.
No comments:
Post a Comment