McMurdo Medical Challenges

Scott Base with Erebus and melt pool (Credit: Steve Allerding)
Conditions: Temperature 19°F (11° with windchill).  Population = 960
(people coming in from field camps and others arriving to unload ships next week)

At 7 PM last night, I got a call from Scott Base.  A young Kiwi Army engineer had experienced rapid onset of a severe headache associated with nausea and neck pain while lifting weights.  She had no history of headaches. This constellation of symptoms qualified as a "Thunderclap Headache" which itself raises the possibility of a ruptured cerebral aneurysm.   Aargh!  I was on call, had been invited to a farewell spa party for Rebecca, and really didn't want to deal with a subarachnoid bleed.  I timidly asked, "How's she doing with ibuprofen?"  Such wishful thinking.

I consulted Dean and he said (of course) that we need to see her.  Damn!  Why does he have to always embrace reality when I'm so valiantly trying to deny it! 

On arrival at McMurdo, the patient felt much better.  The ibuprofen worked! (there's that pesky wishful thinking again).  Her headache had dropped from seven out of ten pain to three out of ten and her nausea had resolved.  Within 15 minutes, she felt completely well and her exam--which started out with a teeny bit of neck stiffness--was normal.

Dean and I decided to do a lumbar puncture and were consenting her when Shawn said "We haven't done an LP here in decades.  You need to call the big boss in Texas".   He put the kabosh on our plan stating we didn't have the laboratory expertise to look at the cerebrospinal fluid.  Anyone who knows Dean would realize that it's dangerous to get between him and an LP needle.  He obeyed but compliantly fumed.

We compromised and I called a stat neuro consult at University of Texas.

  • Her:  If she were in the US, she'd get a CT and an LP in the ER.
  • Me:  "Should we LP her here?"  
  • Her:  "Great idea!" 
  • Me:  "But we are not a CLIA certified lab"  
  • Her: "Well maybe you should just watch her; she got better so fast".  
  • Me:  "You realize that we're 12 hours from a real hospital, right".  
  • Her:  "Perhaps you should medevac her for a CT and an LP".  
  • Me:  "Have you ever seen a subarachnoid bleed get better in one hour?"  
  • Her:  "It's rare.  Maybe you should do the LP".   

Sigh.  As a group:  Texas boss, Dean, Kiwi doc in NZ  and USAF,  we decided not to urgently medevac her but set her up for priority medevac today. 

I saw her this morning before she left.  Completely asymptomatic and upset that she ever told anyone she had a headache.

She represents the tough part of medicine down here. If she were home, she might have walked into an ER and been evaluated within a few hours.  Here, we are always saying, "What if we're wrong?  If we wait and something bad happens, then a minimum of 12 hours stand between that serious event and advanced medical care".  On the other hand, if we send someone when they don't need to go, we bump people off planes who are anxious to get home AND we lose clinic personnel who accompany the medevac. 
The first "Skirt Party".  Scott's Discovery Hut, 1902
Actually, they were putting on a play.
Shawn hasn't had a day off in a month because he's had to cover for our traveling nursing staff.  And tonight is the annual Skirt Party at Scott Base where some man lucky will be crowned "Miss Ross Island".  Shawn definitely wants to throw his sash in the ring.

Skirt Party from a few years ago.

It's a constant balancing act.  Personally, I think we should have done the LP.

Comments

Upi said…
Doesn't this mean that your first instinct "ibuprofen" was right..
Just saying.......
January 17, 2020 at 9:39 PM
dz said…
Quite a write-up you got in the Wall Street Journal this weekend....on a slightly different topic.
January 19, 2020 at 11:54 AM
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