by Robert Boyer, M.D. with permission
As told to medical students in Omaha, Nebraska, April 1997
Big snowstorms are not common in south central Kansas. On this particular Friday it began snowing about noon and by eight o’clock that evening, no vehicles in town could move. Some of you may remember this particular storm, it was so severe. It was bitter cold and the snow fell in horizontal lines, piling up in large drifts. For some reason I was the only doctor in town that weekend.
Late that night the phone rang and I recognized Jim’s voice. His wife was in labor and he said that he felt he could get her in to the hospital. He asked me if I could get to the hospital and I said, "If you get there, I’ll get there." I had delivered his wife before and anticipated no problems.....
I realized that I would have to walk the mile to the hospital. I gathered my warmest ski clothes and goggles and pulled the snowshoes down from their resting place on the wall. How I happened to have snowshoes is another story.... The usual short trip to the hospital took nearly an hour in the biting cold.
When I arrived, the hospital was quiet. Gwen was the nurse on duty. In fact, Gwen was the only one on duty. No one else could even get to the hospital. There were no aides, no housekeepers, no lab or x-ray folks, just me and Gwen and three inpatients who were fortunately not very ill. Gwen had cooked dinner for the patients. She had waded through hip deep drifts to retrieve hot dogs from her home across the street.
My OB patient had not yet arrived so we called home, but there was no answer. Given the conditions we got more and more concerned. To relieve our anxiety, periodically we would look out of the emergency room door to gaze down the highway. Finally we saw something way off down the highway. High off the ground came two headlights moving very, very, slowly. The vehicle eventually pulled into the drive and Gwen and I could see that Dad was sitting atop a large articulating tractor with huge tandem wheels. There was no cab. In front was a bucket and inside a down sleeping bag in the bucket was mom, laboring away. Dad turned in and, hmmmmm, down came the bucket and we helped our patient to the delivery suite. Shortly she delivered a fine, healthy girl.
I was sitting there waiting, like you do after a delivery and things seemed to be going well until I saw the placenta. It struck me as the funniest looking placenta I had ever seen. As I examined it, Gwen leaned over and asked, "Are you OK down there?" I replied, "Why do you ask?" Gwen stated that she was in a lot more pain than usual and her blood pressure was dropping. I told her that we were having a lot more bleeding from usual down below. Then I realized that not only did I have the placenta, I had the entire prolapsed inverted uterus in my hands. I had never faced this before and did not know what to do. I started by getting Gwen to start a couple of IV lines. It struck me as a good idea to get rid of the placenta, so I peeled it off and tried to push the uterus back in place. The uterus didn’t budge and it continued to bleed. The blood pressure was dropping and I knew I needed some help fast.
I showed Dad what had happened and left the room to consult my medical books. My obstetrics textbook told me to call the surgical team and get anesthesia. I decided that the author of the textbook did not practice medicine the same way that I practiced. I managed to contact an OB friend in a neighboring town and when he finally woke up, he told me to get the surgery team and get anesthesia, etc.... I reminded him of the situation and he suggested giving her a transfusion and shipping her. I told her that we had no blood, our ambulance could not make it out of the garage, and no helicopter could fly. We had already tried valium and demerol to no effect. He had nothing else to offer so I wished him a restful night and went back to the delivery room to face a worried Dad. By then Mom’s BP was 60 over zip and I knew this nice lady was going to die if I couldn’t come up with something.
I decided to call an old OB professor at the medical school in Kansas City. I called at 1:00 AM and his wife answered. She told me that he was not at home, but she gave me his phone number at a medical conference in Lincoln, Nebraska. I called his hotel and he answered. He remembered me and bless his heart, he understood the situation that I was in. He told me to get Gwen and search surgery and central supply for anything that could put Mom asleep. He told me that he would stay there on the phone and wait to hear from us.
I put the receiver down and Gwen and I found an old outdated bottle of penthrane liquid and a used whistle-type inhaler. Now penthrane is a volatile liquid something like ether that came with this inhaler-whistle thing that you strapped to the wrist. The purpose of the device was to allow the patient to breathe the gas while awake, but when the patient got drowsy, the arm would fall and the inhalation would stop, a somewhat self-regulating device. I filled the inhaler to overflowing and handed it to Dad. I told them to have Mom breathe the Dickens out of this stuff. As Mom began to inhale, she began to relax. When she was out, I hooked my feet under the table, took my fist, and pushed. Now I’m a fairly good- sized guy but it took everything I had to get the uterus moving. It finally rolled back inside with a pleasing pop. I left my fist in place but soon the uterus pushed it out of the way and the bleeding slowed.
I felt a great sense of relief and wanted to share our great success, but got no response from the head of the table. I realized I was alone again and not feeling very good myself. I looked up to find Mom asleep with Dad passed out on her abdomen. Gwen was definitely "Wacko" from breathing the exhaled penthrane. I retrieved the inhaler and improved the ventilation, keeping a close eye on all of us. Mom’s pressure began to rise and the bleeding returned to normal. Dad and Gwen awakened and the baby was doing great! We were out of the woods. Somehow I remembered to return to the phone and thanked the professor for his instruction and diligence.
I spent the rest of the night at the hospital and checked on Mom and the baby frequently. At about 6:30 AM, Dad asked me if I wanted to ride into town with him to eat breakfast. He had checked and Daylight Donuts was open. I was tired of Gwen’s hot dogs, so I said yes and we were off. I put my ski clothes on and climbed into the bucket. Dad raised the bucket and drove the short distance to the town of Kingman. We reached the three blocks that constitute the downtown and we found no other vehicles, not even tracks in the snow. Dad lowered the bucket, hmmmmmm, and I got out. As I turned to go into the restaurant, Dad put a quarter in the parking meter, and then joined me. That’s kind of a rural thing, too.
We had our breakfast and Dad asked if he could take me home. Not looking forward to the long walk in the cold, I was happy to agree and crawled back in the bucket. Up went the bucket and we moved down Main Street. Eventually Dad turned into my drive and eased me back down. He then asked if I could clean my drive and I replied, " That would be nice." About three passes of the big bucket and the snow was gone and Dad returned. He parked the tractor and shut off the engine. He walked over to me and I see this big guy with tears in his eyes that were freezing down his cheeks. After a long pause, he said, " I know that last night, we didn’t always know exactly what we were doing......... but we did a hell-of-a-job!" I thought a moment and agreed with him, "Yes, we all did."
Now I like this story. First of all its a good story. Second, its a rural health story. You can’t have a professional experience like this in the big city. I use this story to illustrate what is good about rural practice. While I was doing this I didn’t worry about the money I would make or not make, the time it took, or the prestige I would gain or lose. I also learned a lot about medicine, but also much more. Most of all my patient, her husband and the nurse all learned to respect me more, but more than that, I learned to respect the patient, her husband, and the nurse more as well.
Taylor Caldwell is one of my favorite authors and she wrote a book about a physician. She wrote "Dear and Glorious Physician" about the Biblical physician Luke - a book I highly recommend to you all. If there was ever a time in my professional life when I felt "dear and glorious", it was there when I was standing beside the big tractor and the big farmer-Dad feeling a big feeling in my heart that snowy day in February.
Many of you are going to medical school, enduring a lot of stress, making a lot of decisions. You’ve got a lot to think about what you want to do with your lives. You’ll think about the barriers to rural practice, the money you won’t make, the time that it will take from you, the prestige you will lose in the eyes of your classmates, or the lack of educational opportunities. How does this story end if I then note how I went to the office on Monday and sat down to maximize my DRG reimbursement, or figure out how to charge for all that time I spent. Why worry about the charge and how could I spend my time better as a physician than caring for a patient and her child and her husband. What good is the prestige of a medical career versus the respect I earned and exchanged with my patient family.
I may be naive, but I still believe that rural medicine offers the best opportunity to be the best doctor and have the best fun and share the best moments where you will indeed feel "dear and glorious."