authorship

Wilderness Medicine Magazine

Expedition Medicine Column Editor

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The Rogue Medical Blog

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Book: COMING SOON!

BOOK SAMPLE

The patient presented to our tiny clinic in a flurry of acute distress and flurries of snow. The EMS crew had to strap him into a stretcher while holding him standing on a narrow, slippery metal landing, then carry him down four flights of spiraling, external stairs as the snow whipped around them. The ambulance carved through deep drifts, tires sliding across ice, headlights barely piercing the whiteout. When they arrived, the man was limp and unconscious. He was gray. He already looked dead.

I had briefed the team: we have a chance to save a life tonight. We may succeed. We may fail. But we have to try. I apologized to everyone for what was well known as my “black cloud” as we rolled to the resus bay. A healthcare provider with a “black cloud” means they are very busy with high acuity patients compared to someone with a “white cloud.”

The lead paramedic gave me a weary look. “I don’t know if you need to go to church or do yoga or burn some sage or what – but you need to do whatever you have to do to get yourself right with the lord. This is crazy.”

They were a mostly volunteer department and this was their third call of the night.

Everyone moved with practiced urgency. The paramedics and EMTs started helping in the clinic. A chest x-ray was taken within seconds. It showed a pneumothorax (a collapsed lung) and a complete “whiteout” of the remaining lung, congested with fluid. Was that infection? Cancer? The why did not really matter at the moment. He was no longer protecting his airway. The paramedics were manually ventilating him with a bag-valve mask. He needed a chest tube, and he needed to be intubated. Now. In that order.

I inserted the chest tube. A sudden whoosh of trapped air and a splash of blood exploded across my face shield. The paramedic had insisted I wear one as I settled in with my scalpel and the chest tube. I had paused just long enough for her to apply it all. I looked at her through the splatter of blood across the shield and clearly mouthed, “Thank you.” She raised her eyebrows at me with a knowing, “I told you so” glance.

We intubated him and secured his airway, placed IV lines, started pressors to keep his blood pressure from crashing. Everyone was doing something to save this man. I pushed furosemide to draw fluid out of his lungs and steroids to decrease inflammation and buy him time. We started antibiotics. He was way too unstable to stay here. He needed a medevac. But it was nighttime. Medevac had not made it back. There was a horrific storm boiling outside.

I asked one of the EMTs to get on the phone and start calling around for transport off the island for the 800 mile three hour trip to the mainland.

One by one, the commercial medevac teams declined—it was too dangerous to fly and it was past civil twilight. As the storm intensified, we called the Coast Guard as a last resort. I was not optimistic. They agreed to send a C-130, but only if a medical provider could fly with him.

I said yes. We would sort out getting me back here later. That is, as they say, a tomorrow problem. We kept him stable waiting for the Coast Guard to arrive. Several times I thought he was dying.

If they fly all the way here and he dies…

But then his vitals would stabilize.

I grabbed my go bag. We arranged for a colleague to cover the island’s emergency pager and loaded the patient into the waiting ambulance.

“Wait” called out the paramedic as I was about to climb into the back of the ambulance. She pressed a few marked syringes into my hand. Fentanyl, morphine, midazolam. I met her gaze.

“Just in case” she looked grim. I nodded. If he was going to die inevitably and appeared to be in pain or distress, I could at least make him more comfortable as he passed with these medications.

“We will waste these together tomorrow” I said.

We climbed into the ambulance.

On the short tarmac, the arctic wind howled as the ambulance lights flashed against a swirling sky. Everyone worked facing away from the wind. It felt like it was driving ice needles into your face. The C-130’s engines roared. The pilot walked up to me with a serious look and a sense of purpose and asked, “What are the odds this guy dies on my plane?”

He stood facing me. The snow tornado whipping around us. I looked into his eyes. I would feel awful if I mobilized all the resources and risked lives just to have the man die in flight. “Fifty-fifty,” I replied. Then paused and sighed. I met his gaze to let him know I meant business. “But one hundred percent if he stays here.”

To find out what happens next please be on the lookout for the full length book on the spectacular lengths people in remote areas will go to save lives.

speaking engagements

Sarah is an internationally recognized, sought-after speaker and educator who can inspire and motivate your audience to take action. 

Prolific, inspiring and motivational, Dr. Sarah delivers original and powerful messages. A lifetime of adventure, success – saving lives in unique extreme environments – coupled with some humbling failures – Sarah gives a heartfelt and authentic presentation sure to inspire the hearts and minds of any audience.

She has given talks for:

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