Winter race against time
Kelso, Scotland, United Kingdom
The phone rang in my surgery as I was embarking on an insurance medical examination a few days before Christmas. The town outside was strangely quiet, with few vehicles moving owing to a heavy snowfall earlier in the evening. Knowing my receptionist would only have put a call through during a consultation if the matter sounded urgent, I lifted the phone. As I glanced through the window at the nearby streetlight, I noticed that snow was piling down with redoubled force. The well-known voice of a patient—a hill farmer who lived at least fifteen miles up the valley—was calm but contained a note of barely-disguised anxiety. He told me that his twelve-year-old son had come into the farmhouse looking pale and complaining of nausea. Apparently he had been playing on a weak point in the roof of a barn and had fallen onto the concrete floor.
Under normal circumstances a visit would have been mandatory, since the possibility of head injury existed. However, no vehicle would be able to reach that farm that night; the farmer explained there were already deep drifts on the steep farm-road, making access impossible. Hoping that the boy was only concussed, I suggested to him that the boy be allowed to rest (and possibly sleep) in bed for no more than fifteen minutes and to call me immediately after. However, I did not receive a phone call, so I rang back. The father sounded less anxious and explained he had not wanted to wake him—as he seemed to be breathing peacefully and that his color had improved. I insisted that he wake the boy at once. He quickly returned to the phone with the dreaded information that he could not wake him.
Now the gloves were off. There was a strong possibility of intracranial hemorrhage, and I had to attempt to get the boy into the hospital. I set to work. My first call was to the roads department, who almost laughed at my ridiculous request to clear the remote road that led to the farm. All their snow plows were battling to even keep the trunk road open. The only snow-clearing vehicles that might possibly tackle the drifted country roads—those equipped with powerful snow blowers—were on the point of being overwhelmed by the deteriorating conditions.
The controller confirmed what I already knew: the boy’s only hope was to enlist the help of a helicopter from the Royal Air Force (RAF). I spoke first to an officer at the nearest base, who on learning the local geography quickly advised that an RAF base in the north of England was more appropriately placed to respond to the urgent need. An officer there immediately mounted a rescue by helicopter. I was able to give the exact coordinates of the farm, as I luckily had a copy of the map on hand. He told me that the helicopter would be at the location in approximately twenty-five minutes, and that the farmer should immediately build and fire a small stack of straw bales on a level area near the house to facilitate the helicopter’s landing. There followed several phone calls to the city hospital that would receive the patient, as well as to the local ambulance control, who would be required to have a vehicle ready at the grass park where the helicopter was to land.
Having set all these steps in place I could not completely repress the fear that I might have over-reacted, visualizing the young patient walking unaided and no longer concussed from the helicopter on arrival. These thoughts were quickly dispelled when I spoke to the boy’s mother, who was frantic with anxiety as she prepared herself to struggle with her unconscious son along the hastily dug tunnel to the landing site—where her husband and older son were setting the beacon of straw bales alight, ready to guide the pilot in.
I was intensely relieved to hear the welcome clatter of rotor blades over the receiver even sooner than I had expected. I looked out the window and saw that snow no longer fell. I pictured a now less desperately difficult landing, loading, and uplift for the helicopter. I phoned for the last time and gave a message of hope and encouragement to the boy’s mother as she and the older son left the house, carrying the patient, slipping and sliding up the snow tunnel to the helicopter. Thirty minutes after landing, the patient, his brother, and their mother arrived safely in the city park, and the waiting ambulance transferred them to the neurosurgical unit.
I phoned the hospital after a seemingly interminable time had elapsed and learned that on arrival the patient’s breathing had been labored, that his pupils had been widely divergent, and that an immediate scan had revealed a large intracranial shadow—almost certainly a life-threatening collection of blood—possibly an epidural hematoma. A long night ahead, the boy was being rushed to the operating room. I decided I would have to wait until morning to learn the outcome. After a night of predictably disturbed sleep, I phoned as early as I dared. The kindly intensive-care nurse told me the patient had undergone successful drainage of the hematoma. She added that he was in good shape: conscious and already not tolerating his ventilator tube, he appeared to be expressing a strong desire for breakfast. This last I took with an incredulous but grateful pinch of salt; I thanked her and terminated the call as tears overwhelmed me.
It was Christmas Eve when the father, alone on the drifted farm, learned with delight that the Roads Department had made a superhuman effort to open the road linking the farm with the valley, and thence with the trunk road leading to the city. At the same time increasingly good news of the young patient’s rapid recovery was coming from the hospital. So it was with a lightened, joyous heart that on Christmas Day he packed the farm Land Rover with provisions, blankets, and presents, and set off along the still hazardous, but passable country road leading to the hospital, his wife, and sons.
When he reached the hospital, he was quickly guided to his son’s ward and found the whole family waiting excitedly for him in a side room, which was specially made available for them and decorated for a Christmas Day meal. I could only imagine the joy that must have enveloped the parents as they embraced and hugged their two boys, the patient smiling broadly with his head enlarged by a turban of white bandages. The ward staff had made this wonderful, heart-warming effort to create a homey, welcoming, colorful space for the family to celebrate the best Christmas that they would ever enjoy.
A week later I took my two older children to enjoy some adventurous sledding in the hills. The conditions were ideal, and after several hours of energetic bob-sleighing we found ourselves—by chance or subconscious design—at the farm where this great drama had taken place. I knocked on the door. It was soon opened by a small boy with a white, turbaned head. This was my first sighting of the patient for whom I had so recently made those dramatic, anxious phone calls—could it have been only a week ago?
I later learned that in his letter of grateful thanks to the RAF crew for having saved their son’s life, his father had mentioned that the patient was extremely disappointed to learn—on re-entering the conscious world—that he had been the cause and centre of a dramatic airborne rescue, which he had missed in its entirety. In response, the RAF offered to give him and his Dad a trip in the helicopter as soon as the young man had recovered, and they took the RAF up on this kindly offer. The ride inevitably proved to be exciting, but it could not hope to measure up to the original trip over night-time hills, ghostly white in moon-light—with a blazing beacon to point the way!
CHRISTOPHER H. CAMERON, MB ChB, MA, MSc, now a retired general practitioner, was born in 1940 in Edinburgh, Scotland. Originating as a student of classics and ancient history in Edinburgh University, he underwent a “Damascene conversion” after a year and moved to the medical school. He became a general practitioner in Kelso, a small country town in the Scottish Borders. After twenty-five years in general practice, he recommenced studies as a “mature” student at Edinburgh University, receiving an MA in English language, Scottish history, Russian and Gaelic, and an MSc in an etymological and linguistic study of non-standard bird names still used in the Scottish Borders. He enjoys playing viola and writing poetry and prose about his experiences in general practice. He and his wife, a nurse, married his first day in general practice, and enjoy very much their three children and four grandchildren.
Highlighted in Frontispiece Summer 2012 – Volume 4, Issue 3
Summer 2012 | Sections | Doctors, Patients, & Diseases