Under Extreme Circumstances: Session Two

Discover my second suggestion for surviving life "Under Extreme Circumstances."

Posted Jan 10, 2019

If you’ve followed my blog since it began in October 2018, you know I’m writing a series titled "Under Extreme Circumstances." This series is based upon events my wife and I encountered while living in the Arctic as told in my memoir “On Call in the Arctic: A Doctor’s Pursuit of Life, Love and Miracles in the Alaskan Frontier.”

"On Call in the Arctic" illustrates, by the telling of true-life adventures, how my wife and I adapted and survived a life far removed from any we had ever known and how I practiced medicine and surgery far beyond my level of training and experience under the most archaic conditions imaginable. 

Thomas J Sims, author
On Call in the Arctic
Source: Thomas J Sims, author

In my first blog of the series I wrote that, as the blog progressed, I would discuss three traits I learned as a child to survive my life in a family burdened with addiction. I would discuss these traits and describe how these childhood lessons carried forward to my adult life, enabling me to adapt to the harsh living and working condition in the Arctic, even up to the point that I could perform feats of medicine and surgery far beyond what my training and experience had prepared me for.

Thus far, I’ve discussed the first of those traits: the ability to improvise—a trait that can help us conquer seemingly insurmountable obstacles when life presents us with problems that appear to have no solution. In this post, I will begin a discussion about the second principle I learned as a child: the ability and willingness to be flexible.

Try this exercise. Take a moment to sit back, close your eyes, and imagine yourself in a situation of extreme distress where you’ve been placed in a situation that, on the surface, has no solution. It could be dramatic, such as trying to rescue a person from a burning building or car crash, or something less extreme yet equally devastating, such as the unexpected loss of a loved one or death of a child. Think of something that could be life-threatening or emotionally crippling if you were the only one capable of doing something about it—and you couldn't.

That’s the way my life was almost every day in the Arctic. Here’s an example from my book that illustrates the point.

It was my birthday and I was irritated when, in the middle of a dark freezing Arctic night, I was called to the clinic to see Juliette Shaw, wife of my best friend Garrett. Juliette was seven months pregnant with her first pregnancy, but she was in labor. Though she and Garrett were friends, I hadn’t taken care of Juliette during her pregnancy because the couple wanted the whole “Alaska experience,” and that included a home delivery. I was opposed to a home delivery for Juliette, fearing potential risk of a first delivery, and since I was the only doctor in the town of Nome (7000 people) plus an additional 7000 people in 13 surrounding native villages, Juliette had no choice but to have her prenatal care done by an inexperienced public health nurse who gave immunizations at the school where Garrett worked.

Juliette’s nurse was away for the Christmas holidays when Juliette went into premature labor and, without a way to contact the nurse or obtain any medical records, I was left on my own to singlehandedly manage the problem of her impending premature birth with no knowledge of what her prenatal course had been like.

Lying on a tattered old gurney, her face a grimace with a contraction, I knew something was terribly wrong the moment I began to examine Juliette. Her uterus was small and misshapen, and I had trouble locating fetal heart tones. I had no X-ray, no ultrasound, no way of determining what was happening except my clinical exam. And then, when Juliette hollered out that her baby was coming and she wanted to push, I looked down, and to my astonishment saw a small, blue fetal hand fall out of her birth canal.

I felt a line of sweat break out on my forehead and couldn’t believe my eyes. I’d read about it, heard about it in a distant lecture, but had never seen one and suspected I would never see another because they were so rare.

Juliet had a shoulder presentation—a horrible condition in which her baby was lying crossways inside her womb—and the presenting part coming down the birth canal with labor contractions was an arm and hand. It was a position that could not be delivered by a normal vaginal delivery and, isolated in the Arctic with no one else but me to help, was the perfect storm for fetal and maternal death.  

Here I was, weather-bound in the middle of the Arctic with no help, no general anesthesia, no instruments or clinical training to use them, and no experience to handle such a catastrophe. Yet, I knew without a doubt, if I didn’t take action within the next few minutes, I would be losing a mother and child.

Anchorage was 500 miles away—too far for a chartered aircraft to make the flight in time, even if the weather would allow such a flight, which it wouldn’t have. If I tried to set up for an emergency C-section, Juliette’s uterus would rupture before I could get a spinal anesthetic done and she would bleed to death and her baby would die.

We struggled to get a phone call across ancient phone lines into Anchorage so I could consult with an obstetrician. When we finally got a doctor on the line and explained the emergency, I pleaded with the doctor for his advice and he told me to pray. Then he disconnected the call.

Source: Flickr

It was an extreme circumstance where the life of my friend and her baby were in my hands. If I was going to try anything at all to face the issue and take charge, I had to forget everything I’d ever learned about conventional obstetrical deliveries, be flexible in my thinking, and follow my instincts. It was all I could do... 

In my next post, I’ll tell you what I did and pass along some tips you might find useful in helping yourself be flexible when you find yourself dealing with a life situation under extreme circumstances.