It's -24 degrees (closer to -40 degrees with the wind chill factor) and my lungs are very unhappy. The walk between the hospital and my current habitat is getting more painful as frost develops on my eyelashes, and my face literally hurts from being pummeled by the gelid winter wind. Bottom line: I have a huge stockpile of cab vouchers and I'm not afraid to use them!
I definitely have some kind of viral respiratory infection which makes my crazy work day feel a bit surreal. You! I mutter to my airways. Don't you dare succumb to a bacterial infiltration! One of the nurses very kindly offers me a highly prized (and much appreciated) chocolate truffle from Dilettante which I eat immediately, along with zinc gluconate lozenges and a ridiculously high dose of vitamin C. I make several calls to the hospital in Anchorage and to the medevac team about an 85-yr-old man with severe dementia and a slow GI bleed who needs to be transferred to a higher level of care. I am glad that I document everything so well in my notes, because I can't remember a single thing I said to either Anchorage or Lifemed. One of the ED docs hijacks my patient's medevac flight for a police officer who accidently shot himself in the leg with his service revolver and shattered his own femur.
Now I'm discharging 5 patients in rapid succession (including the 400-lb woman with a COPD exacerbation who keeps making up reasons to ask for ativan and morphine but still manages to be quite endearing). But wait! Is the 4-yr-old with RLL pneumonia really ready to fly home? Why has his WBC increased to 22? Can I blame it on the prednisolone? Five minutes later, his CRP comes back as 10.39, which is much improved from the initial value of 23--hooray! I have managed to complete all the discharge summary dictations, pushing through my viral haze with herculean effort. But I immediately get hit with 2 direct admissions: a elderly man with pneumonia from Kusko Clinic, and a 42-yr-old male with a bad case of LLE cellulitis extending to his groin from Delta Clinic. Then there are multiple garbled RMT calls from the health aide in Kipnuk: something about a possible suicide in the village...there's a pool of blood on the floor of someone's home...but the health aide isn't allowed inside the house because the state troopers are investigating the scene. It took an accumulated 30 minutes of phone calls to garner those juicy bits of information.
Now I'm swabbing the posterior fornix of a 20-yr-old primip at 31 weeks with preterm contractions in order to get a fetal fibronectin test. Don't touch your vagina, I told her 24 hours ago. Don't put anything inside your vagina, including your boyfriend's penis. Her ultrasound yesterday revealed a closed cervix measuring 2.7 cm which was mildly reassuring, but we couldn't get the FFN at the time because she was a couple of hours post-coitus.
Three hours later, an alternate medevac arrives to transfer my GI bleed patient to Anchorage and I am greatly relieved, because his hematocrit has dropped 10 points in 2 days and he can't get an EGD or colonoscopy at our tiny hospital due to his multiple comorbities. Where is the fried dough that the inpatient clerk gave me, I wonder. Did I eat it in my feverish delirium without realizing it? Probably.
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