**Transport 1**

My phone started to buzz with an incoming request for transport to our tertiary care center (the “Destination Hospital” as one of my mentors Dr. Costakos always says) as I maneuvered my 75th 24-hour call shift of Fellowship Training late into the night. By now, I had led multiple rapid responses or codes, pronounced an unfortunate number of neonatal deaths, and triaged scores of such calls for transport. I was becoming accustomed to giving advice for those asking for Help, always conscious and always nostalgic for the years I spent as a Locum Tenens in the field at the same facilities. Always remembering my close colleagues, friends and myself in similar situations… The fear, the stress and the anxiety as we we would stabilize a sick child as best we could waiting for more resources and back-up. The communication center came on the phone, “Hey Trevor, we have a facility from out west calling and they are having a hard time intubating this baby. Our transport team is rapid launching.” “Ok, put them through.” I will never forget the shrill chaos on the other line as the nurse reverberated communications from the doctor on what had happened, “We think we’ve intubated… We think there’s a tube in? I don’t know, we’ve tried like 5 times, we’re in now i think… But we don’t have color change (a sign of CO2 detection and adequate ventilation indicating appropriate positioning in the wind wipe as opposed to the esophagus). We’re at 12cm.” I paused, took a deep breath knowing they were unlikely in the right place at such a deep measurement, and very slowly asked, “How is your heart rate? I think you might be too deep to be intubated, i fear you’re in the stomach or right mainstem. I want you to slowly pull the tube back and see if you have color change.” “Ok. Our heart rate is good, over 100, we’re slowly pulling back but there’s no color change… *indistinct chatter* The doctor and I agree, I don’t think we’re intubated. We’re going to pull the tube out.” “Ok wait a second… When you do, I don’t want you to try to intubate again. Your heart rate is good… When you pull the tube out, I just want you to bag (use a bag and mask to ventilate manually as opposed to a ventilator).” “Ok, we’ll do that.” “How is it going?” “Good, we have chest rise, our heart rate is good.” My heart raced and as it did, I spoke even slower. “Ok, listen to me very carefully. I know this is scary, but, I want you to bag the baby until we get there. You can do it, I know you can. I’ve done it before myself, for 53 minutes… So I know you can too. You’re doing a good job. We’re coming.“

*****

If you’ve read other parts of my blog, you’ve possibly heard my story about the time I woke up to a dire call for a delivery of an extremely premature baby of 28 weeks of gestation working at one of my locum jobs in rural Maine. As a still relatively newly minted Pediatrician, I was unable to intubate the baby and was highly aware of the risk of causing airway swelling and trauma if I tried too many times without success, possibly gravely compromising the success of the transport team when they arrived. I led a resuscitation with 2 nurses, a CRNA and an ER doctor that had very rarely or never been put in this situation and made the hard call to bag the baby until the transport team we had called from 2 hours away could rescue us. One by one, we would pass the bag around the circle providing positive pressure ventilation to this fragile baby’s lungs helplessly waiting for the team to get there. I will never forget the feeling when, at close to an hour, the team landed, intubated the baby, secured and airway, and saved the day. Months later at another locum job, I ran into the same transport team and found out that same baby had survived, successfully made it through his NICU course, and went home, alive and well.

The lessons I learned as a Locum Tenens have been branded into my soul. I bleed with the memories of the situations that pushed me beyond my comfort zone and redefined who I was. I call upon these experiences to guide my decision-making, my behavior, my presence and my advice every single day that I wander through my continued education and career. I will never forget the morning report and sign out to the on coming day team when I explained with tears welling up in my eyes the fright I vicariously felt for this small hospital during that call, a phone call between the communication center, the house supervisor, the transport coordinator, myself and a small scared hospital far away, and how no one in that room would understand what I was seeing or what I felt. Locum Tenens gave me a heart I didn’t know I had and responses I didn’t know I was capable of giving.

*****

Our transport team arrived after 1.5 hours by urgent helicopter and the outside hospital was continuing the bag the baby. He was alive and his heart rate was always preserved. He was intubated by our transport team on the first attempt and transferred to our facility alive and stable, and eventually he went home.