Woman with ruptured ectopic and minutes to live

We received an SMS from Walagi alerting us to a woman who had a ruptured ectopic and was very pale. Her abdomen was distended, and old blood was drawn after a culdocentesis. Time was critical so we loaded up the Beaver and began our journey.

Kila and I have our own checklist in preparation for medivac and we never spoke a word until we were inside the Beaver. I think we were worried about the urgency of this mission and that the mother may not hold out long enough. Kila prayed the mother would hang on and she did that several times before the morning was over.

We made it over to Walagi within an hour and touched down as graceful as a pelican.

Our mother was sick indeed. Lying in the dark ward with no lights and an acute life-threatening condition, she seemed utterly hopeless. After introducing ourselves to the patient, Kila set to work applying the compression garment with the help of staff. Our patient was pale and in pain when we log rolled her to get the stretcher slide in place. Her blood pressure was 85/50 mmHg, but she was conscious and talking. We couldn’t feel a pulse, her respiratory rate was 48 and her limbs were cold. We didn’t waste time getting another IV line in. I didn’t want her BP to go any higher and increase the blood loss in the abdomen. We brought our own oxygen as health centres rarely have it and this gave her some comfort and gave us time.

We quickly got her into the Beaver, released the ropes and pushed off.

During the journey, Kila spoke to the mother, holding her hand and praying: “you are strong, hold on, we are nearly there”.

Approaching the Owen Stanley from out at sea when it’s covered in clouds, presents the pilot with some challenges and decisions. Do I cross over near East Cape, where the ranges are low at around 1500 feet and then track coastal back to Gurney down Milne Bay? This adds 10 minutes to the trip, plus extra fuel. Or do I risk doing straight for the ridge just west of Gurney hoping to find a gap in the cloud bank and cross at 2800 feet? I decided upon the latter, as it was the shortest route, saving time and fuel.

As we moved closer, the cloud base was hugging the ridge but there were some layers with gaps here and there. Pushing further and further into a point of no return, I could see the low land over the ridge and the Gurney airstrip in the distance. I reflect now on how that decision to push harder and risk the uncertainty ended up saving us precious minutes.

Kila was encouraging the mother to hang on, holding her hand as the wheels touched the tarmac. She was already hypoxic with oxygen saturation dropping to 94%.

We taxied up to our hangar with no hospital ambulance in sight. There was no time to make phone calls or wait. We loaded the mother into the Landcruiser ute, just left the Beaver and rushed off for the hospital with hazard lights flashing and headlights on.
We delivered the mother straight onto a labour ward bed. Within seconds there was an army of health staff attending to her, collecting blood for x-match, oxygen and assessing vital signs.

While this was happening, our mother went severely hypoxic and into respiratory arrest. She just couldn’t hold on any longer. The staff intubated her in the labour ward and moved her quickly into the theatre for a laparotomy.

She lost nearly 4 litres of blood and survived, but only just by a few minutes.

Thank you to the obstetric team at Alotau Hospital who do an amazing job. Our work is only made possible by your caring support and the wonderful spirit of our team, Matthew, Col and Tara.

On reflection, there were many times during this retrieval when time could have been wasted sticking to protocols or not wanting to push the boundaries. Kila and I both know we had helping hands that day.