Daytrip to Noumea

One morning during the ward round, my boss showed me an email written in strange English about a patient in Noumea with severe ARDS. Asked what my thoughts were, I answered I think she needs ECMO! and was told that that was indeed the plan. I asked if I could tag along, not really expecting that it would really happen – after all I am supposed to be at work looking after patients! But the next thing I knew, the head honcho of cardiac anaesthesia had organised a seat for me on the retrieval plane.

So on this sunny afternoon, we stood outside RPA waiting for a taxi with our dark green ECMO bags (2 large duffles and 2 square bags, one of which contained the precious Maquet Cardiohelp machine). The whole setup was surprisingly compact and light, and as the surgeon would later remark, we can put someone on ECMO in the supermarket!

We went the backway through the taxi driver hangouts of Alexandria to the private part of Sydney airport, adjacent to the domestic terminal. Our terminal was a fancy building with hippy paintings, plush leather couches, fancy coffee machine and plentiful glossy magazines. Aesop handwash in the bathroom – what planet am I on? I thought. As we waited for everyone to arrive, domestic jets landed on the tarmac right in front of our noses. 

We boarded our Learjet 55, which was a vast improvement on the smaller Learjet 36 that we used to fly around NT in. The aircraft was relatively spacious and well set up with the removal of 2 seats to accommodate the stretcher. The cardiac anaesthetist, surgeon and I occupied the back pod of 4 seats along with our giant oxygen bottle. The temperature was regulated (no more teeth chattering at altitude) and the stability of the aircraft during takeoff and landing was excellent. There was even a little pulldown service area where one could have a hot drink and some snacks from the mini oven! It was pretty damn luxurious compared to my previous experiences with small planes in Darwin.

The others slept but I was too excited to sleep, and ended up chatting with the co-pilot and the Careflight nurse most of the way. We watched the sun set, gliding through the thick cloud layer, scattering orange rays everywhere. 

As the light faded, we descended through myriad layers of cloud moving in different directions, finally landing in Noumea to light sprinkling rain. 

The police met us on the tarmac and we filled out forms by the dim light of the ambulance that had come to fetch us. It was the first time I was stamped both in and out of the country at the same time! They obviously weren’t worried about us overstaying.

The ambulance was positively ancient, the back piled with equipment that did not fill us with confidence. The cervical collars looked like they’d been reused hundreds of times, dirty packets of gauze and grubby looking bottles of fluids lined the shelves. From where we sat on a ricketty bench we could hardly see outside as we drove the 40 minutes from the airport to Gaston Bourret hospital.

I saw a Bingo! Parlour sign as we pulled into the hospital street and wondered if that was a popular form of entertainment in New Caledonia. Then we were there, stumbling out onto the footpath at the front entrance. We loaded our bags onto a discarded hospital bed which didn’t have any functioning steering, brakes or sides. A petite woman managed to help us wheel this into ICU Service de Reanimation which I thought was such an apt name for ICU.

The ICU was brightly lit, sparkling clean and full of modern equipment – it would put many Australian hospitals to shame. The nurses and doctors were dressed in white scrubs and this did indeed make them stand out as the health care professionals – I really liked it!

We visited the patient along with the French intensivist on duty. We looked at the ventilator, infusions, blood tests and X-rays just as we would do at home, then a few phone calls were made and we decided to hold off putting the patient on ECMO for the time being. The pilots have specific rules about how long they can work before they need to have a mandatory rest, so by our calculations we could have two hours to observe the patient and make sure our decision was correct. 

What else to do but dinner? The French intensivist generously offered his car, which we promptly drove onto the wrong side of the road. Just as well there was hardly anyone out on a weeknight at 8pm, and everything seemed to be shut including the supermarket! We went to a waterfront restaurant, ate some super fresh fish, drank Perrier, and chatted about how this would be the most expensive dinner any of us would ever have (imagine, a private flight to New Caledonia just for dinner!)

Back at the hospital, we confirmed the patient was not deteriorating and packed our bags to leave. I was surprised that the intensivist was still on duty, and he told me they usually have no registrars! They have one at the moment, so one of the ten lucky intensivists get to be on-call with a registrar but she doesn’t do on-call by herself. Seems like a pretty tough life, but I guess it’s only 5 nights a month and the patients are getting the best standard of care. Just walking past the rooms, it seemed like the disease acuity in the 10-bed Service de Reanimation was pretty high – almost everyone was ventilated, and about half on dialysis. It’s apparently so busy that their 12-bed HDU mostly serves as a second ICU. 

On the way back to the airport, I sat in the front of the ambulance with the solid Melanesian ambo who looked like he could defeat anyone by sitting on them. The freeway was straight and featureless, I felt deplete of adrenaline and quite drowsy. I slept for some of the three hour flight back, waking up occasionally to see a perfect semi-lunar moon shining brightly above our heads like a street lamp. The field of stars was  simply incredible as we were flying above the cloud layer. We were so close to them that it was like we could reach out and touch them, yet they stretched so far beyond our fields of vision that they were infinite.

It was freezing in Sydney when we landed, and the customs officers looked as exhausted as we were. We lugged the gear back to the perfusion office, and I crawled into bed at 3am finally. And that was that, the end of our Noumean adventure. I had thought excitedly on the way to Noumea – in the years to come I will always remember this, my first retrieval mission. Even though we didn’t bring back the patient, I think I still will remember this day as when my love for retrieval was re-ignited. Now I’m certain I have to do some real retrievals!