DAY 22

I’m halfway through my time up here. They decide to put me on-call on my own for the first time, even before my preceptor has left. The day goes smoothly enough, though I keep hitting snags with cases that turn out to be more time-consuming than they appear. The lady here for a PAP smear turns out to also have a perforated eardrum, needs to be booked for a mammogram, and thinks her hernia is coming out again. The kid with a cough might just have a viral infection, but then it sounds like he’s been choking on his feeds. I stay until 8:30PM seeing patients, and finally catch up on my charts as I wait for my heart failure patient to pee enough to ease the fluid in his lungs. Shelley, my personal saint today, brings me homemade lasagna, and I wolf down my first proper meal of the day. The patient’s breathing gets better, so I send him home and ask him to come for a follow-up tomorrow.

I’ve just stepped into the shower at 9:30PM when my phone rings. A mom tells me her little one has just started a fever but doesn’t like taking tylenol. She’s run out of tylenol suppositories. It seems like a trivial thing to make a trip for, but the last thing I need is for this to turn into a 3AM call for a febrile seizure. I promise to meet her at the clinic in half an hour. Ten minutes later, she calls me back. “I dug around and found some! I think we can manage for tonight.” It must be my lucky day.

Too soon.

Five minutes later, my phone rings again. “My son just got in a snowmobile accident. Someone’s bring him to the health centre right now.”
I’m already pulling my sweatpants on. “Is he breathing? Is he awake?”
“Yes, but he’s in a lot of pain.”
That’s…good…maybe? I decide to hold off until I lay eyes on him before I decide to call in Shelley, who’s my back-up tonight.

The patient walks in, splinting his side, two people holding him up. He’s in so much pain that he can’t sit or stand still. He was driving, drunk, with a friend, at 100km an hour with no helmet. He remembers waking up in the snow, not knowing what had happened, then drove home before the excruciating pain started. There’s no external bleeding and his vitals are okay, but I watch him hold his abdomen and his back. I think of all the organs underneath, all the things that can rupture, all the things we can’t see. I call Shelley in.

I’m putting an IV in him and he won’t hold still. I still haven’t gotten the hang of these IV supplies. I hit a huge vein, and of course blood comes spraying out everywhere again, all over the floor and the side table. Shelley walks in at this moment and her eyes widen. It looks like someone’s been murdered in here. “It’s not from the accident…I just have a good vein,” I reassure her.

We’re fortunate to have a doc in the community this week and he comes in to see the patient. What we need is an ultrasound, but Shelley shows me our machine, which is the size of a dresser and looks like an 80s IBM computer. Maybe a dinosaur would know how to operate it. We try to get an xray to see any major blood pooling, but the machine, on this of all nights, refuses to work.

My phone rings again. “I think my mom’s having a stroke or a seizure…I’m not sure which.”
“Has this happened before?”
“Yes, she had a mini stroke a few years back.”
I don’t even bother asking more questions. “Bring her in,” I say. Come one, come all, I sigh inwardly. It seems that even out here, I’ve found my way back to the ER. We have no choice but to call in a third nurse, my poor preceptor, who had just settled into bed.

Both patients need to be medevaced out, we soon decide. But of course, it’s hours before they can even give us an ETA of when the plane will land. So we stabilize, wait, and hope for the best.

Soon, we send Claire and the doctor home. After that, I send Shelley home too. I don’t think she wants to leave me with two potentially critical patients, but she was on-call the previous night and looks like she’s about to fall over sideways. The patients are finally settled and resting, and I keep walking between their rooms to check up on them.

The possible stroke patient needs to pee. I get her into a wheelchair with the help of her daughter. Her one leg is dead weight, but we manage slowly. Almost as soon as I’m done, I see the other patient’s mother poking her head out down the hall. He needs to pee too.

We get him up with some difficulty, as he holds his side and yelps in pain. I put a bucket in the toilet to measure the amount and get a sample. When he’s done, I blink twice to make sure I’m seeing correctly. He’s peed out a litre of bright red bloody urine. My heart drops into my stomach. I get him back into bed and recheck his blood pressure – thankfully still stable. I notice a ring of bruising forming around his eye, but still nothing on his abdomen or back. I check his hemoglobin. It’s dropped from 129 to 102. I don’t know where he’s bleeding from, but I know we are slowly running out of time.

The medevac team calls to say they’ll arrive at 3:15AM and are thankfully on time. But the team is made of only one nurse who will be taking both patients at once, and I pray that they’ll stay stable for her. It takes until 4:30AM before both patients are packed up and ready to go. I’m finally seeing the light at the end of this 20 hour tunnel. I’m in the midst of offering to go to the airport to help them transfer up the stairs when my phone rings again.

“My girlfriend just took a bunch of pills,” a panicked young man tells me. My dreams of finally climbing into bed dissipate. I feel like I’ve been punched in the gut. He doesn’t know what she’s taken or how much, just that she’s angry at him for calling me. Angry is good, I think. Angry means that she’s awake, breathing, and talking.
“Can you bring her in? It’s really important that I see her to make sure she’s okay.” My body aches in protest.
“I’ll try,” he says, “but she really doesn’t want to come.” He hangs up.

I turn to the flight nurse. “I’m sorry I can’t go to the airport with you. I have a possible overdose coming in.”
Her eyebrows shoot up. “Do you want me to wait? If they also need a medevac, I’ll be the one coming back to get them…and it’ll take at least another 3 or 4 hours before I can get back here.” I glance at the trauma patient, still holding his side, who needed a full body CT and probably surgery, like, five hours ago.
“No,” I tell her. “If there’s an overdose, I’ll handle it. You need to get him out of here.”

I wait an hour for the overdose patient, who never shows up. I’m anxious for her, but also selfishly relieved. I tell the security guard to call me right away if she comes. I finally crawl into bed at 5:15AM, after sending a text to my nurse in charge, asking if I can come to work after lunch instead of at 8:30AM.

I receive the trauma patient’s CT report two days later. Miraculously, no head or neck trauma. But he had a lacerated spleen and kidney, and a broken rib. That spleen laceration must have been a small one, or he would have never lasted those five hours. Considering the accident he was in, he should count his lucky stars.

I, on the other hand, am hereafter known as a black cloud.


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