Saturday, August 7, 2010

Alaska Tails

Sherry is safely back from her annual back-country paddling trip in Alaska. You may recall that last year, she had a real problem being stalked by grizzlies. Her husband subsequently failed to keep his word by purchasing, and learning to use, the necessary weapon that would ensure their safety.

Fortunately it was a remarkably griz-free adventure this year; except for the last day.

Sherry and her husband are dropped off by a bush plane, paddle to a certain point and then rendezvous with the pilot at a pre-determined time and place. This year, because her husband was doing some type of observation for the Park Service they were given a satellite phone (and a Jr. Ranger badge). This would serve to be a fortunate happenstance.

At the end of their trip, Sherry and her husband Dick were awaiting pickup on the appointed day by a small float plane; a little pond was to be the landing area. Sherry told her story:

"The wind was blowing a gale, and there was quite a bit of chop on this pond; it was relentless. These float planes have to land precisely, otherwise they would tip over and crash. The pilot made three or four passes, and I knew he wasn't going to be able to land. Sure enough, he called us on the sat phone and said there was no way. He has to come from two hours away, so he said he would come back the following day, and for us to call him at 6:30 AM to let him know about the wind conditions".

"I didn't sleep all night. The wind kept howling, and I was concerned that we would be stuck another day. It was so bad we had the tent tied to the gear bags so it wouldn't blow away. Finally, just about 6:00 AM the wind died down. Dick called the pilot who said he would arrive about 9:00. I was relieved and settled back in to get a couple of hours nap at least".

"At about 8:30 I got up, and Dick and I packed up the tent. We were pretty much out of food, but had a couple of granola bars so we pulled them out to eat while we sat on the gear bags and deflated canoe to wait for our ride. That's when we saw it: a giant grizzly. It was down at the end of the pond eating a caribou. Dick and I kept our eyes on the bear, but he seemed pretty engrossed in his breakfast and didn't seem to notice us".

"About this time, the wind picked up again with a vengeance. Now I was nervous, as if I wasn't when I spotted the bear. Maybe 10 minutes later we spotted the plane. I was thinking we were in some pretty serious trouble if he couldn't land, because the wind was gusting."

"The pilot had to come in low, right over the bear in order to land, so I know he realized we had a serious situation. The bear was pretty pissed off about it, too, roaring and waving a paw at the plane. The pilot tried to land, twice, a third time, then a fourth; each time the bear was roaring. I really didn't think we were going to get out of there; I had no idea how much fuel was available to burn on failed landing attempts, so I was feeling pretty desperate by this time. All I could imagine was spending another night with this really angry bear in our back yard".

"Finally, there was a lull in the wind; I had a feeling that this was going to be the last attempt. The plane came in so low I thought it was going to hit the bear, who was definitely not happy. At this point,the bear did something really odd; it THREW the caribou at the plane! I have never seen this before, nor had the pilot.

"The plane landed safely, loaded us in and we were on our way. The bear retrieved the caribou and continued with his meal, paying no attention to us at all. It was a great trip, but boy, was I glad to get out of there".

We are all happy to have Sherry home safely, but the phrase "when caribou fly" has become our new favorite saying.

We saw 24 patients last night. This, in a 6 bed ER with two nurses and one doc. Plus, the doc was Gil. Lord love the guy, but he is a cautious soul and we had some sick patients. Plus at least 6 dental paineurs, of which two left because the wait was at least 90 minutes. Can you imagine?

The campers from the several overnight camps kept coming. I don't know, perhaps it is the first time in a year many of these kids have been outdoors; they have fractured fingers, been stung by bees/mosquitoes/ spiders and one camp hamster (a campster?). As my son used to say, "ham comes from a hamster".

One day a week we offer a free walk-in blood pressure clinic. Not too many people use it, maybe a dozen or so. But for some of these crusty Yankee old-timers, it is perhaps a day out; and free to boot. One of the cranky old ladies never remembers to bring in her little booklet, so she gets a new one every week. We give these out gratis; I envision her house with about 3,000 little booklets, each with one or two blood pressures written in it. I seriously doubt that her PCP ever sees these readings. Or anybody. She is a little ritualistic, needing to sit for at least 5 minutes to "settle", then another 5 minutes to rummage around for the booklet she does not have. Several minutes are expended in divesting "only the left arm!!" from about 4 sweaters. Finally, she will squint up at me suspiciously and ask me who I am, and if I am new. We go through this every week. After taking her blood pressure and writing it in the new booklet I have provided, and she clucks and mumbles and frets her way back into her clothing, she is out the door, pushing a walker sporting 4 tennis balls in the legs.

Having your triage area tied up for 20 minutes on a free service: priceless.

One woman came in who just wants me to check her O2 saturation. Why? "I just had an asthma attack and if the reading is normal I don't want to be seen".

OOOOOOOOOOkay. We offer a 15% discount on ER co-pays that are paid right away; we take major credit cards even. But, you can't collect on this type of time-wasting activity which included informing the patient to return if she stopped breathing. Or whatever.

New Cathy emerged from an extended visit with one patient. "Well, she wanted to know if I had found Jesus, and I couldn't get out of the room; any suggestions for next time?".

"As the token atheist at a Catholic hospital, I am perhaps the last one to ask; I could give you some talking points from my perspective, but I doubt it would go over well", I said drily.

Gil says, "That happened to me once; the patient was jumpig up and down, waving his arms and yelling, "Praise Jesus! Praise Jesus!", so I just started jumping up and down yelling "Praise Jesus!" too. Then security took over".

"My son suggested that this might be an effective way to deal with telemarketers; I can just imagine. 'Hello, I am calling from XX Loan Corporation, are you interested in refinancing your home?'. 'Why no, but have you found Jesus?'. Could work pretty well", I said.

The hits just kept on coming. One little guy, I don't know how he managed this, fell off his bike and cut the soft palate in his mouth pretty badly. The rubber grip on the handle bar was mostly worn away, exposing much of the hollow metal edge, which wound up piercing the roof of his mouth. He was so scared, but did OK. It could have been so much worse.

The Last Patient of the night (whom we finally saw about midnight) was actually having an anxiety episode. She insisted that it was "overactive kidneys". I was too tired to pursue that she perhaps meant "overactive adrenal gland" that is located ON the kidney. The adrenal gland produces cortisol, a hormone that is important for several body functions, such as blood pressure regulation and release of insulin; it is also released in increased amounts in response to stress. Also, it is responsible for anxiety reactions, which is pretty much a "flight or flight response" gone haywire. That is tonight's science lesson, class.

Ativan helped, and she left with happy adrenal glands.