Nursing Student Braves Alaskan Storms to Bring Patients to Safety

Richard Ervin knew he wasn't going home anytime soon as he stared into the storm-tossed Gulf of Alaska. It was the last day of an incredible one-week SEARCH rotation for the nurse practitioner (NP) student in the village of Akutan, located far from the mainland on the remote Aleutian Island chain. "The weather was absolutely horrendous," he recalls. "It was blowing and raining and spitting snow. The clouds were so low you couldn't see much above the water's surface."

Fate soon intervened in an unexpected way that demonstrated the challenges that face clinicians who work in isolated, underserved locations like Akutan—providers such as Ervin's SEARCH preceptor Maureen Brown, ANP. Brown, a Massachusetts native, is a former NHSC Scholar who had arrived in Akutan two years before Ervin's visit in March 2002.

"Maureen is pretty amazing," Ervin smiles. "It was quite an eye-opening experience for me. She did everything, from managing the clinic's books to radiology to running the pharmacy to caring for people who come in with heart attacks. Maureen is on call 24 hours a day, 7 days a week."

Ervin was hardly a novice. Prior to enrolling in the NP masters program at University of Alaska in Anchorage (UAA), he had spent almost a decade as an RN, most of the time working in hospital intensive care units. That experience ignited an interest in primary care within Ervin. "I got tired of dealing with severe illnesses," he says. "I saw a lot of heart attacks and strokes and a lot of people who hadn't taken care of themselves. I thought maybe there's a chance of keeping people out of the ICU."

He heard about the SEARCH program and decided to check it out during his final semester at UAA. It was an opportunity "to go into the bush and see what it was like," Ervin noted. He was also interested in seeing the Aleutian Islands, an area of Alaska that was new to him even after living for 20 years in America's northernmost State.

Ervin flew to the village on a small floatplane that "landed on the water and then taxied up onto the pavement." His first view of Akutan's stark landscape impressed him instantly. "It was barren," he recalls. "There were no trees but it was beautiful." Akutan is a community of about 1,000 residents located on the site of an old Unangan Alaskan Native village. "There's no road but they have a boardwalk that runs through the town," Ervin says. The Native Alaskans, who make up 16.4 percent of the community, live traditionally by fishing and hunting and collect treaty allotments from both Alaska and the United States as a Federally recognized Tribe. They live in small, neat homes.

He was surprised to see a huge fish processing plant located a short distance down the bay from the village. Ervin soon learned that there was little connection between the factory and the village. "It's two different worlds," he notes. Few villagers are employed at the plant, which hires immigrant laborers, mostly Hispanics, Filipinos, and a few Whites. Workers are housed and fed at the plant which also has its own clinic staffed by a physician assistant.

Maureen Brown welcomed Ervin to the village clinic. "She was incredibly pleasant and very knowledgeable," he says fondly. She instructed him on the basics of primary care on the frontier and soon had him doing everything related to patient care. "At that point, I wasn't out of NP school yet and didn't have a lot of experience in primary care," he admits. "I was seeing whoever came through the door with whatever problem. I prescribed, diagnosed—whatever I had to do to get them better." He even "learned how to take X-rays, which I had never done before." He developed enormous respect for Brown's resourcefulness and skill in her isolated medical facility. "It's difficult because you're the point person out there—you're it!"

Most of the cases Ervin treated were minor—sore throats, stomach aches—until the night before he was scheduled to head back to Anchorage.

"On the last night I figured I was going to be staying there awhile because of the weather," Ervin recounts. A patient came into the clinic around midnight and seemed to be suffering from small strokes—TIAs (transient ischemic attacks)—as well as high blood pressure and chest pain. "We got him settled and were trying to figure how to get him out of there to a mainland hospital," Ervin continues.

A few hours later, another severely ill patient arrived, carried in by a crew from the fish processing plant. "He had been out on a fishing boat and had started to lose consciousness," Ervin explains. "They brought him in and weren't sure what was going on with him—they thought he was having a heart attack." Brown and Ervin assessed the patient. He had to be shaken to be aroused, and spoke only Spanish. Fortunately, both clinicians speak Spanish and were able to understand that he had a "problem with his head."

Ervin recounts what happened next. "Maureen was great. She did a neurological exam and discovered a shunt at the back of his head and a palpable drain into his abdomen." The NP realized the patient most likely had a blocked intracranial shunt, a life-threatening situation. "We knew we had to get both of the patients out to Anchorage as soon as possible."

Finally, Brown was able to summon a Coast Guard helicopter that managed to land in the fierce storm. Brown and Ervin had wrapped up the patients on gurneys and helped load them into the chopper. Ervin got onboard and rode along, bidding a dramatic farewell to his instructor of the past seven days. He escorted the patients to Anchorage, and, with this life-saving feat, completed his SEARCH rotation. Both patients survived and recovered from their near fatal episodes.

Brown's report on Ervin's rotation was glowing. She found him to be "an outstanding student: wonderful, warm, and compassionate. He will be a fabulous nurse practitioner."

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