Fractured Skull. Medevac. Stat.

I was asked multiple times while I was on furlough if I still help out in the clinic.  Many of you know that this is my work area of passion.  I’m still there.  Growing.  Learning.  Just often it is not appropriate to write about what happens there.  “What happens in the clinic, stays in the clinic”. : )  Sometimes though, patient cases become public knowledge and sometimes we can all learn from the stories that emerge from there.

Saturday afternoon, 4:00 p.m. we are leaving the international school after hosting one of the dorm boys for part of the weekend.  As we drive down the steep hill, my midwife friend, Fiona, is driving middle of the road up the hill.  Her driving seemed a bit erratic.  Yet I just brushed it off that she had taken the corner wide and was on her way to pick up her son. 

We keep going to our new favorite spot.  The lake road.  There we drank in the ever REFRESHING scenes of the lake and rolling hills.  A feast for the eyes and soul.  The sun slipped over the hills as we walked.  Then we headed home.

Darron had much on his mind. He was going to do a round trip journey to a village near the PNG boarder, early the next a.m.. One way, the drive was said to be 5 – 7 hours.  He had many details to work out, like getting extra fuel and details that I knew not of.  He was to depart at 4 a.m. the following morning.  So promptly upon dropping us at home, he was off to find gas and line up many details.

We had not even been home for 5 minutes when I get a call from Fiona’s husband.  Also a text comes through at the same time from our doctor.  “Evac,….frx skull motorbike accident.”  Mike filled me in on the details.  I grabbed my keys.  Told the kids to behave (its handy having 17 and 15 year old brothers) and headed out the door.  I knew it would be a long night as planes generally do not land on the Sentani runway after dark.

Our patient was an 18 year old girl (here on a short term assignment) who was learning for the first time to ride a motor bike.  She was on the relative quiet street where they live.  No helmet.  She got confused and instead of braking, accelerated and went into a deep cement ditch. Her forehead hitting a cement wall.

Fiona witnessed the whole accident, as this is a dear friend of hers.  She managed to get her in their car and drive up to the clinic (she tried to wave me down when we passed on the hill (but unfortunately we missed her cues for help) where our doctor was going to sew up the nasty forehead gash.  When our doctor was washing out the wound, that was full of grit, cement, paint, etc……she noted it went to the bone and the skull was indented and visibly jaggedly broken, like displaced puzzle pieces.  Quickly the washing stopped, a dressing was placed, an IV started and IV antibiotics administered.  The patient was alert and oriented throughout all of this.

By the time I arrived at the clinic, many phone calls had already been made.  To insurance companies.  To family and friends.  To pilots here.  Fiona’s phone was non stop texts buzzing in as people around the world began to send messages of prayer and comfort and concern.

As the evening clicked on the seriousness of the injury was very real to all of us medical staff checking on the stability of our patient.  We imagined the difference had she been in a first world setting.  Stat x-rays, MRI’s, CT scans, monitors and pressure gages, consulting neurologists and…..  Instead in remote Island Papua our patient lay on an exam table with a neck collar on because she was complaining of neck pain and we were taking no risks.  Our technology consisted of assess, assess, and assess again.  Let me not forget the ancient IV pole that is so tall, that you have to tip it over in order to hang the IV bottle.  No pump to control the drips accurately.  A blood pressure cuff gave us a window of thought into the patients possible inter cranial pressure. A flash light allowed us to check how her pupils were reacting, again another clue of pressure.  And her level of conscience was our biggest indicator of her stability. We had very few medicine options to try and make her more comfortable without sedating her.

Throughout the evening, friends came by and prayed.  There was such a sweet presence, despite the criticalness.

As the evening wore on it became clear that insurance was not going to pay. for a medevac.  This was because the patient was not wearing a helmet and did not have a drivers license for the motor bike. At that point we asked one of the local mission organizations if they would be willing to make the flight to an Island in Australia.  They were willing, and we began to set everything in motion for a 10:00 a.m. departure.

As the night progressed the medical staff divided up the time and we covered the patient with care until departure time.  I must say, our team is made up of selfless individuals.  We all do this because we love medicine and patient care.  None of us receive a penny for out time or commitment.  The plan was that I would stay until 2 a.m. and then Alisha (our school nurse) would cover the rest of the night and Karen would take over at 6 a.m..  When Dr. Di left around 11 p.m., another Doctor who just happened to be in town came up and stayed with us until 1 a.m.  I enjoyed getting to catch up with her and we pushed in a lot of fluid and watched the heart rate and blood pressure drop.  I was alone with the patient from 1 – 2 a.m. and I began to feel uneasy about her condition when Alisha came in, so I stayed on.  Close to 3 we did another one of those hourly neurological assessments.  I’m glad I stayed because after that things became much more complicated and Alisha and I were very busy for the next hour.

The team who worked this case.

Darron stopped by at the clinic at 4:30 a.m.  Set for a day of unknown adventures and challenges.  His car was full of people who would join him in the journey.  He handed me the keys to the outer gate of the aviation property so that I could slip in before the gate was opened for the day.  We embraced quickly, with watching eyes from the car and he was off.

At last at 5 a.m. I felt like our patient was stable enough for me to leave and try get some sleep.  By 8:30 Fiona was texting me that they were ready to take the patient to the plane.     The minute I stepped back into the clinic my adrenaline was flying.  We rolled the patient onto a backboard.  And strapped her down.  Waiting outside was an expatriate vans that had seats that laid down (the only one we knew of).  All the gear was grabbed for possible “what ifs” on the medevac. 

Once at the airport, came the task of getting our patient transferred onto the plane stretcher and settled with everything.  She looked very pale at this point and she was perspiring.  We all felt nervous about her flying for 4 hours in a non pressurized plane with a fractured skull.  Dr. Di and Fiona would make the flight with her.  Many more prayers were offered and much love and support were given.  And then they were off.

As the next 4 hours clicked by, we were all anxious to get the texts to know they had made it.  What a relief when at last we heard that our patient was safe in a first world hospital.  There she was held until that evening, and then helicoptered to a bigger hospital.  There x-rays, and MRI’s revealed a 6 cm fracture of the skull.  No surgery needed.  They just cleaned out the wound well and glued the skull and steri stripped the wound.  The next day she was transferred to yet another hospital where a neurology specialty team was.  The doctors were all amazed that she was not leaking Cerebral Spinal Fluid from a fracture that significant. 

We are all rejoicing at the positive outcome, of what could have been such a different ending.  I am also so grateful to God whom I believe began healing our patient in our little clinic with very limited technology, but full to the brim of compassionate, believing people.

Also the huge take home message from this is ALWAYS WEAR YOUR HELMET and think about things like drivers licenses and insurance.  There you go…..all of you who love medical missionary stories. : )  And here is to grace that God extended as we cared for our 18 year old, fractured skull patient, with very limited “resources”.  Puji Tuhan (Praise the Lord)!