While on a remote assignment, we had the unusual privilege of seeing to the comfort of a patient with a terminal illness and attending an anticipated death. If a patient finds comfort in the idea of dying at home, or in a remote location (like an island or mountain town) without tertiary hospital services, we believe we should do everything in our power to assist them. It was, of course, a sad but beautiful and ultimately peaceful event. A few days later, we were very surprised to be awakened to attend to an imminent birth, which occurred outside, in a very remote location, in inclement weather. Initially — we had no supplies (not even PPE because, honestly, we ran out in pajamas), but we delivered the baby — who was coming whether we were ready or not. We had called out the proverbial “cavalry” and they showed up en force. Never underestimate what a mother, paramedic, or RN might know more than you when it comes to experience — SO thankful for the team that showed up. Once we were able to evacuate to a safe indoor location and feel more confident that the baby and mom were stable — we were able to breathe again and contemplate the events of the week. We are born. We live. We die. Make the most of your short opportunity on this earth.
We hadn’t delivered a baby since 2005 — so we reviewed the standard of care that is to be provided after delivery for mother and baby AND called an OB specialist for guidance (colleagues are the best — never burn a bridge — phone a friend).
Mother was given 10 units of Pitocin IM and we were prepared to give 1 gram of Tranexamic Acid IV to mom if bleeding appeared to be an issue. We helped her get cleaned up and started an IV to hydrate her.
Baby blood glucose was tested, erythromycin ointment was placed in the eyes, Vitamin K1 1 mg was given IM — but the standard newborn vaccination for Hepatitis B was deferred until they could be transferred to a tertiary care facility because there was some discussion that this is routinely given on discharge?
For a team that is used to wilderness medicine, trauma, orthopedic injuries, appendicitis and MIs, we were very happy with the level of care we were able to provide and the guidance we were able to obtain from colleagues to safely get mom and baby through — what to many of you might be a simple routine event — but to us — was an incredible, miraculous, terrifying, way WAY out of the comfort zone, experience.
Later, the team complimented me on how calm I was when they arrived and how calm I remained. It was the nicest thing they could have said to me because I DID NOT feel calm! I told them not to confuse a little German stoicism with calm.