On the December day that a critically wounded gunshot patient needed help, two fairly new health aides on duty at the Savoonga clinic got the call.
Freezing rain delayed the medevac flight and meant that when it did arrive, it would only do a touch and go, stopping just long enough to load the patient and leave.
The pressure was on. The women, who became fast friends during their training, hadn't been prepared for this type of critical injury. Whether the patient would live or die was up to what Brianne Gologergen and Danielle Reynolds could pull off as they waited for the emergency flight to land on their island home in the Bering Sea, closer to Russia than mainland Alaska.
Theirs is a familiar scene.
In rural Alaska's isolated villages, "health aides are the backbone of health care delivery," explained Angie Gorn in an interview Monday. Gorn is the president and CEO of Norton Sound Health Corp., which oversees the region encompassing Savoonga, one of two villages on St. Lawrence Island. "Without health aides, our villages would not have health care on a daily basis. They didn't go (through) the years and years of schooling that a physician did, but they are essentially performing the same front-line service in their communities when it comes to an emergency or a trauma."
Health aide certification, a model unique to Alaska, is a four-level process. Each level requires training and field experience before advancing to the next. By the time you reach level three, a clinic can bill Medicaid for the services you provide. Completion of level four certification paves the way for a person to earn the highest status possible -- community health aide practitioner.
Gologergen and Reynolds had just reached level two when they got their crash course in dealing with a life-threatening gunshot wound. Reynolds knew she wanted to go into health care after taking an EMT class in high school. Gologergen dreamed of being a pediatrician, but after three years of college in Anchorage, she realized she was a hands-on learner and left the books and her degree behind and returned home. Both women saw ads for health aide positions and applied.
And there they were on that day in December 2010: newbies faced with a major emergency. To make matters worse, the third health aide on duty that night was in another room tending to a cardiac patient. They were on their own.
"We had just started about five months before and we were already taking calls. The call came in and we responded to a gunshot wound," Reynolds said.
Once inside with the patient, they called an emergency doctor in Nome, who videoconferenced with them on a large screen in the clinic's single emergency room. The patient, the doctor told them, would need a chest tube, a procedure generally handled by higher-level practitioners. The doctor talked them through the surgical procedure, making do with supplies available in the field trauma kits the clinic stocks.
"We did everything the doctor told us to. We put the chest tube in," Reynolds said. "He told us, 'You girls f---ing did it! You girls did it. You did such a good job.'"
When the medevac flight took off, the intensity of what had just happened washed over them.
"We laughed and we cried happy tears and we just gave each other a hug because we did it," Reynolds said.
"Outside in this dark quiet night and we realized the magnitude of the emergency and that the patient lived. The relief of seeing a patient alive and out of here to get better care is such a relief off your shoulders," Gologergen said.
Within two months, it happened again. Another gunshot wound. Another chest tube.
"Our clinics are the ER and the primary clinic all in one, and you just never know what's going to come through that door," Gorn said.
The health aides also make house calls and go to trauma patients when the patients can't come to them.
"We're just like an ambulance department, but we just have snowmachines and four-wheelers," Gologergen said, laughing.
"Something unexpected could happen at any time," said health aide Mary Ann Seppilu, who once fetched an emergency patient by boat when a woman from the island's other village, Gambell, needed a medevac but the flight couldn't get in to the south side due to high winds. Seppilu made a three-hour boat ride to get her, motoring from Savoonga to Gambell, where she loaded the patient onto a backboard at Gambell's dock, put her in the boat and made her way through choppy seas back to Savoonga.
On the front lines every moment of every day, the health aides themselves struggle to define their roles. They are supposed to be "the eyes and ears for the doctor," according to Gologergen. But they do so much more.
"We do everything. We're (like) nurses. We take vitals, give advice, dispense medications. We do our own labs. Urine samples. Sometimes we put in catheters. We do stitches. We see ear patients and send ear pictures to the audiologist. We do something from each department. We're on call 24 hours at a time and rotate every 24 hours," she said. "We have a lot of crazy days."
One day it might be putting in a chest tube. Another, delivering a baby. Gunshot wounds. Overdoses. Seizures. Heart problems. Strokes. Appendicitis. Bowel obstructions. Botulism. Common colds. Strep throat. Bronchitis. Ear infections. The health aides have seen it all. Meanwhile, it's the season for village hunters go after whales and walruses, so the health aides know to be prepared to do a lot of suturing and to also be on the lookout for what they call "seal finger" -- a cut that becomes infected after handling marine mammals.
The three-room clinic is busy all the time. To make room for more patients, they've moved their supplies to outdoor storage units. On average, the clinic sees about three people per hour, not including emergencies that require an offsite visit, home visits for the elderly, or after-hours calls.
The health aides pretty much know everyone who comes through the doors. They're bilingual and can speak to patients in Yup'ik, an especially helpful skill when seeing an elder. And friends and family know if they've got a question about a headache or an unusual lump or how much Advil to take, they can call their health aide friend or family member to get an answer. Even when off duty, the health aides are on duty.
It can be exhausting, emotionally draining work. Adrenaline rushes. Flashbacks. Staying calm through emergencies. Saving lives. Losing others.
"It feels [like you] have more loss because of the way you feel. It's hard losing somebody. Death is hard. It's heavier," Reynolds said.
They hold their emotions at bay until it's safe to let them them out.
"We do the helping first and then we can let it out after everything is done and we know the patient is going to be okay," Seppilu said.
Many times, those emotional bursts come in the privacy of their homes, where tears of joy or sadness have a chance to flow.
"There was one time I worked 39 hours straight and I was so tired. And every time I would be done with a patient and would lie down and get another call and I would have to come back to work. I almost cried because I was tired and overwhelmed," Reynolds said.
Norton Sound corporation makes behavioral health counselors available to the health aides and is diligent with the outreach after major incidents. But the health aides say their strongest allies and cheerleaders are each other.
"All of us health aides, we all know what we go through, so we understand each other and we support each other," Reynolds said.
Because of their exceptional service under extraordinary conditions, including managing a recent tuberculosis outbreak, the Savoonga health aides will receive this year's Distinguished Providers Award from the Healthy Alaska Natives Foundation, the fundraising arm of the Alaska Native Tribal Health Consortium.
It is a well-earned honor for this group of health aides who truly live their work. And they do so with resilience, excellence and compassion for each other and those they serve.
Gologergen summed it up best: "It's hard to just clock out. You are a health aide 24/7."
Jill Burke is a longtime Alaska journalist writing from the center of a busy family life. Her father swore by "Burke's Law No. 1 -- never take no for an answer." Meaning, don't give up in the face of adversity. The lesson stuck. Share your ideas with her at jill@alaskadispatch.com, on Facebook or on Twitter.
The views expressed here are the writer's own and are not necessarily endorsed by Alaska Dispatch News, which welcomes a broad range of viewpoints.