Hi again,
January is almost over and although the temps remain from the single digits
to the minus teens, the days are seemingly more pleasant. We have been having
clear weather for the last two weeks and it seems like it will continue. The
down side is that when it is clear, it is colder. Then when the wind has a mind
to misbehave it can be downright painful. The upside is the northern lights
have been out almost every night and are always a source of enjoyment, and
in their own way, mystical. Daylight hours have extended from about 10 AM until
around 6 PM and being sunny outside helps relieve some of the cabin fever.
It can be misleading though, because the beautiful sight of the sun shining on
the white landscape just speaks to me to come out and play. When I fall for the
trap on occasion, the wind and cold that have been waiting for just such a
moment of weakness, pounces on me with a vengeance. Naw, it's not that bad (mmm........).
Sometimes it's not that bad (better?). Let’s just say I am looking forward to
March and April when the days are longer and hopefully a bit warmer and at least
the ice fishing will be in full swing. Folks here are traveling around on their
snow machines like it's nothing however. It is a common sight to see dark
patches on the face, nose, and cheeks of folks from frostbite on unprotected
skin as they ride.
I received an email not long ago from a friend encouraging me to not only
keep writing, but to make sure I include everything, not just the good. I guess
I needed that bit of encouragement as there have been some incidents I have been
reluctant to write about. As I have written in the past I look at life here as
living with Beauty and the Beast. The Northwest Arctic has the highest
incidence of people dying before their time of anywhere in the country. This
includes accidents, suicides, and homicides, (although homicides are not that
common thank goodness. Buttttt.......it would be, and probably is easy here to
disguise a homicide as an accidental death). In the last three weeks we have
had four deaths of young males under 30. First there was a suicide by hanging.
Then a questionable suicide of another who assaulted his significant other then
stabbed himself in the chest. One night last week an individual was brought
into the ER who reportedly had gotten drunk and was found outside by his family
who put him to bed. Later he was found in bed not breathing and covered with
vomit. The ambulance crew started CPR and the ER staff coded him for a long
time without success. Then a former hospital employee I knew who worked in
security, reportedly shot himself in the head playing Russian roulette at one of
the villages after he and the other participants had been drinking. I talked
with one of the MD's here who was staying in the village that night and was
summoned just minutes after the occurrence. His description of the scene leaves
doubt in my mind about the report, although suicide would not surprise me. This
young mans body came back last night from Anchorage after being autopsied. There
were probably close to 50 people down by the morgue after his arrival and it was
a very solemn sight to see all the tearful faces. God, my feeling is that
suicide is the most selfish act an individual can perform. It is a permanent
solution for a temporary problem and the person who performs this self centered
act checks out. Every one else is left behind with a lifetime of pain and
questions.
One Caucasian who has been
here for over three years put forth a theory about the high mortality of the
young. His theory is that before modern times arrived here, the mortality of
folks living a subsistence life style was high due to the harshness and nature
of the land. Now that modern times, medicine, and so forth have come he feels
the mortality figures would probably be about the same if statistics existed.
According to him just the methods would be different. Who knows? I do know
that the apathy that seemingly pervades the native Indians in the lower 48 is
also present here. But these people do have the benefit of being able to
continue the subsistence lifestyle if they choose to, which is not always the
case in the lower 48. At the same time however this great land definitely takes
its share. There is a service today for the former hospital employee and I am
at work as I write. This has provided a lull allowing me to type at least part
of this letter. The quiet is a bit disconcerting however. I do fear what may
come next as when we have a string of deaths it is always unknown when or at
what number it will stop.
I want to stop with the morbidity of this letter but there is one other
thing of which I must write. Two days before Christmas the MD doing telemed
handed me a fax about a patient coming in a on commercial flight from one of the
villages. The fax stated this was a 24 week pregnant female, status post
appendectomy from approximately 10 days prior, that was performed in Anchorage.
She had severe abdominal pain unrelieved by the narcotics given at the village
clinic. On arrival in Kotzebue I got a call from the airplane carrying her
stating she was at the airport screaming in pain. I dispatched the ambulance to
pick her up. My thoughts were she was either septic (a general systemic
infection) or she was bleeding into her abdominal cavity. I got all the usual
ER accouterments ready for her arrival. She was still screaming on arrival and
I immediately started a large bore IV, drew blood for a general workup, blood
cultures, and a type and cross in case she needed blood. I went to the desk to
get the blood off to the lab and my tech screamed that the patient was in the
bathroom hollering, "my baby is coming". We rushed her back to bed and got the
ER MD in stat. The Dr said to call a code and get the neonatal resuscitation
equipment in-now. He stood there with his hand on the baby's crowning head to
keep the baby from delivering (once the shoulders are delivered an infant begins
to breath, this was to keep the baby on internal life support via the placenta)
until backup had arrived. She ruptured membranes and a terrible stench pervaded
the ER. The delivery was then allowed to occur and when the
infant was delivered, the face was almost black. I have to be honest, and also
sorry to say that when I saw the child, I breathed a sigh of relief because I
felt it was stillborn and we wound not have to do a neonatal code. One of the
doctors detected a faint heartbeat and started resuscitation protocols. We
contacted Providence Life Flight in Anchorage-a special neonatal/pediatric
medevac team from Providence hospital who dispatched their crew. We worked on
the baby for four hours and the team arrived just minutes before the baby was
pronounced. I actually had the easier part as the mother was my patient from
the start and others were involved in the effort on the infant. The mother was
grateful and thanked us for our efforts. When I left the hospital that night
after being there for over 16 hours, the mother was on inpatient and holding the
child. This was just about 30 minutes before Christmas Eve.
I am always torn about whether to write about these things for a number
of reasons, not the least of which is patient confidentiality. Another is I try
to second guess my motives. Am I tooting my own horn at the expense of others?
I don't know. For now I will just rationalize to myself that it is to allow a
glimpse of our life in this beautiful but sometimes harsh land.
Carlo
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Last updated:
08/29/05