Page 20 of Dr. Alaska
Lee ran through her cardiac anatomy. There was likely an occlusion somewhere along the watershed of the left coronary artery. Hopefully, Bruce would remain stable until he reached Fairbanks where the cardiac cath lab could open the blockage. Unfortunately, her patient needed the cath lab now. LifeMed helicopter or fixed-wing couldn’t fly in this weather. Even if the ambulance could safely speed, he wouldn’t receive intervention for at least three hours. Time was heart muscle, as they said.
The HUC’s portable phone rang. After a moment, she turned to Lee. “Lab’s calling with a critical result. Troponin is now elevated at 0.15.”
Troponin. A marker of heart damage. The levels rose as more heart tissue was starved of oxygen.
No surprise. “Got that number for Fairbanks?” she asked the HUC.
Lee grabbed a seat in the central work area of the ED to call. Ten minutes of discussion included tips by a helpful critical care doc along with the on-call cardiologist in a three-way conversation. They walked through the plan for Lee to administer the clot-busting medication TPA. It would be the first time she’d done that by herself.
Here she was, truly practicing full-scope rural medicine at the end of the world. Completely on her own.
Only, she wasn’t alone. Nurses and techs had come running to help with the code. The whole team made this work.
Lee waved Deirdre and Amberlyn over. “We need to give TPA and then send him on to Fairbanks.”
Deirdre tapped her lip as the three of them walked back into the trauma bay together. “Amberlyn, if you can get the protocol checklist, I’ll pull the TPA.”
The way Deirdre remained calm was impressive. Lee quivered inside like a southern rattlebox seed pod in the fall.
“I’m assuming they want us to drip and ship?” Deirdre was saying.
Aka administering the dose while Bruce was en route to the heart center.
“Yes,” Lee said.
“Not a problem, Dee,” Maverick said, securing the transport vent tubing. “The dream team of Hilda and Moose know what to do.” He lifted his chin at the two new medics who arrived.
Louise and Maverick huddled with their colleagues to give a report, their voices murmuring medical shorthand that Lee only half heard.
Lee stared at Bruce, now connected to the transport ventilator Tom was monitoring, the hisses and whooshes syncopating various beeps. Gently patting Bruce’s sheet-covered leg, she sighed. She had to talk with his wife. Aggie was waiting in the family room outside the ED. One of the environmental services staff who was a friend of Aggie’s had apparently dropped what they were doing to keep her company.
Another huge sigh escaped Lee as she smiled at the team around her. “Whew. Anyone else want to pass out, or is that just me?”
Everyone raised their hand, and she got a few grim laughs. Someone suggested going for drinks.
If only. Lee’s call continued until Monday morning.
“Okay,” she said to the team members still present. “Last time I’ll ask. Anything else that we’ve missed? Anything else we need to do before transport? TPA’s started along with the other drips, and he’s tolerating them well. Weather issues?” she asked Maverick and Louise, who stepped back as the newly arrived medics prepped their equipment.
The new medic, presumably Hilda, shook her head. A beanie covered her hair, but some red strands escaped at the nape. “Every day is an iffy weather day in Yukon Valley. Don’t worry. Moose here will get us to Fairbanks.”
If the petite paramedic didn’t look like anything like a Hilda, her tall, thin partner who Lee judged to be around fifty didn’t look like a typical Moose.
Hilda continued, “I have zero desire to deal with another cardiac arrest on the bus ride.” She and Moose worked with the rest of the team to move Bruce to the EMS gurney. They quickly secured him, and Hilda tapped the TPA IV bag and crossed herself before patting the gurney handles. “Let’s boogie, Moosey.”
Her partner shook his head as they exited. Louise followed behind them with a backward glance at Maverick.
Lee spun in a slow circle in the silent and still trauma bay, her ears ringing. Wads of packaging, plastic needle caps, IV luer lock caps and stopcocks, and a small puddle of saline fluid littered the floor.
A full-body shudder ran through her. She’d taken care of what needed to be done. Barely.
The team had performed amazingly well, despite not having any specialized staff available. Wow.
Training was one thing. Real world practice without any safety net was something else entirely. Lee had never truly experienced something like this situation before. Never known the terror of being the very last line of defense between life and death. In every way, this situation was as different from her practice in Georgia as it could be. Foreign. Cold. Uncomfortable, like leaning backward over a cliff while trusting a safety rope to hold. She swallowed against a hard lump in her throat.
No time to process. Lee needed to talk with Aggie.
Maverick stepped in the room, zipped his medic bag, and stood, hefting the bag over a shoulder.
