There are certain memories throughout my career that have become somewhat of what I consider imagination flashbacks, the times where a memory or thought has solidified itself in the setting of an imaginative scenario that becomes a checkpoint to reflex my mind to from time to time. The times when only one of my senses is engaged in the memory, particularly and specifically, I mean phone calls where my eyes can only see as far as my third eye can conceptualize. Time and time again I flashback to memories of situations I was only partially present for, as if looking through one looking glass only to find myself conjuring up an image in another.

*****

It was part way through my first year of Neonatology Fellowship when it happened… A phone call came in at 5AM as I was nearing my 13th hour of work, counting down the movements of the clock as the light began to brighten outside of the window shedding clarity on the falling snow as the temperature dropped below zero: Help, please help.. A hospital almost 3 hours away had been urgently calling every facility within a 300 mile radius to ask for solace, hoping to find a place and a team that could come to transport a small 900 gram (2 pound) baby for a life-threatening abdominal perforation requiring emergent surgery that couldn’t be performed at their hospital. They had called multiple other teams, but as the weather deepened into the polar vortex it grounded all air travel, and the baby wasn’t stable enough to go by ambulance on the road. I called down to our transport center to see where we stood with our team, “Call back in an hour, maybe our helicopter can go if the weather gets better…” So we waited. An hour passed and I desperately called down to see if things had changed and find that the weather had actually worsened no longer allowing us to send any helicopters for longer than expected, but… maybe in another 2 hours, when the other pilots are ready to take the airplane out, if we can find a window of weather to go, we can make it work… But, 2 hours… That may be too long.

I called the small facility back to speak to the doctor taking care of this very sick baby to see if some temporizing measures had stabilized the baby – she was on the oscillator (our highest form of ventilation) but her blood pressure was decreasing and the acid in her blood was building up despite the norepinephrine (IV adrenaline), all signs of grave septic shock. I updated her with the bad news that our helicopter couldn’t make it, but that even if by a miracle the weather eased for our airplane to go, there was a high chance the baby wouldn’t survive the trip to us given how sick and unstable she already was… The frigid temperature would make it impossible to keep the baby warm, a necessity for survival for newborns… The transition from one breathing machine to the next, already fret with turbulence… There was a high chance that even if we could come to get the baby, I was adamant the family was given the honest and hard truth, the baby could die in the airplane or at our hospital, far away from it’s parents. Still, we held out hope while simultaneously continuing to discuss the importance of how we live our lives and whether peace would be better served holding the new soul and accepting nature.

At 8AM I called back to our communication hub… Now there was no team until 10AM… But, the baby was still holding on… And finally, at 10AM a team was ready and the airplane took off, but, barely into the air and the weather became so torrential that it forced them to come back home… The next time to attempt a weather check was 3 hours away. I had left by this time to go home after a 17 hour shift, took a nap, and when I woke up, had heard that the family and the team at the small hospital had come to terms with fate, and the decision had been made to withdraw care in the face of futility. The weather had brought us to terms, our humanity in the face of nature became surreal, and the baby was given peace.

*****

I would love to tell you that these stories are few and far between. I would love to tell you that those of us that have or do work in small hospitals don’t have stories like this etched into our own hearts. I would love to tell you that I normally can promise safehaven… But, I can not. The world is still full of geographic divide that forces our hands to tremble when we realize that being too far away from a major city can mean you are suddenly decades back into the past with the lack of resources. The ability of medical transport, something I am personally fascinated with and in awe of after my time as a locum tenens, is limited, as is all of medicine. In some parts of the world, and to the surprise of many, some parts of the United States, pregnant women are forced to move into a hospital wing weeks before delivery because of how far away they live limited by ferry availability or predicting weather apocalypses like ours. In others, despite having the money and the know-how, the access to help is easier thought of than found; some live in a desert and are unaware of it until it is too late. We tend to take for granted how lucky we are until we have seen the other side of the token.

As I shakily worked through those transport calls that morning, I could hear the raw sadness in the voice of the providers on the other end as they acknowledged so earnestly that, maybe if they had been able to get this baby to a surgeon and a different center, maybe if this had happened in the summer instead of the winter, the baby would have survived… I could feel every single emotion in her voice as hope slowly slipped away with each moment as the acidosis worsened as I flashed back to the time I had had a small premature baby in Central Maine with no team to get her… “I understand. I know a lot of us may not here, but I truly do. I have been where you are. I am sorry.” I hung up the phone, saw the emergency rooms and the small towns and the lovely people from all over the country that I knew faced these challenges so often, and cried.

Image Credit: https://www.ensunet.com/stranded-it-costs/