Mucomyst for Dummies

Now we've got a strange combination of rain from the sky with stubbornly persistent slush and ice on the ground, and all flights have been cancelled.  Medevac has been on hold for most of the day, so the RMT calls have been out of control.  There are patients in the villages with broken ankles and dislocated shoulders who can't book a flight out because of the weather, and we can't activate a medevac for a non life-threatening condition.  Some of the smaller clinics are running low on morphine and tylenol #3 for the patients with painful injuries who can't get to Bethel.

To top it off, I get 12 calls from a health aide about a 17-yr-old girl who was drinking last night and suspects she may have been sexually assaulted but can't recall the exact details.  She started feeling depressed, so she decided to overdose on tylenol.  She tells the health aide that she took 10 of the 325 mg tablets; when I briefly consult with the ER doc, he says there is no way to confirm whether the girl took 10 tablets or 100 tablets since depressed adolescents are notoriously unreliable historians, so she needs to take the oral mucomyst that is standard issue at all the village clinics, given the astoundingly high rate of suicide attempts here by tylenol overdose.  The health aide tells me she can't find the mucomyst.  I ask her if maybe someone else knows where it is.  She calls me back to say no one can find any mucomyst anywhere.  I ask her to check with Emmonak which is the nearest village.  She calls me back to say that Emmonak has no mucomyst.  After conferring with the ER doc again, we decide the girl needs to come in because excess tylenol could seriously fry her liver, so I activate the medevac.  The health aide calls 10 minutes later to say actually Emmonak does have mucomyst and they will send it over.  I call medevac and apologize profusely for wasting their time.

Meanwhile, between checking on my 82-yr-old patient admitted for an egregiously out-of-control lice infestation (I feel mildly pruritic just thinking about it) and chatting with a floridly psychotic 31-yr-old male on a psychiatric hold who wants to know if my pager is a recording device and whether I believe in human clones, I have sketched out a frighteningly detailed flow chart for the health aide who is waiting for the mucomyst to arrive because she seems a little...confused.  Mucomyst for Dummies, based on the 17-yr-old girl's weight in kilograms, tracing out various dosing schemes depending on whether Emmonak sends the 10% or the 20% solution.  Apparently mucomyst has an extraordinarily unpalatable flavor, so it needs to be mixed 1:3 with a deliciously cold beverage like orange juice or soda.  Otherwise, no one would want to drink it.  Frankly, I think their marketing department should consider changing the name of the product to something that sounds more...appetizing.