Aftershock — YourED

In January 2011, 27-year-old Thora Kristjánsdóttir flew to Ōtautahi Christchurch in Aotearoa New Zealand to complete her sixth year of medical school.

Accompanying her was her six-year-old son, Halli and her mother, Anna Lydía, who looked after Halli while Thora was working. They settled in a town called Lyttelton, which was approximately half an hour out from Christchurch.

On 22 February 2011, Thora had just completed a month-long rotation in the Christchurch Hospital emergency department and was in her first week of a rotation on the anaesthesiology ward.

She was having lunch in the tearoom, sitting beside a fellow Icelandic doctor, when the earthquake struck. They both huddled under the table, hoping it would be solid enough to protect them. “We just looked at each other and were like, is this ever going to be over?” she says now.

Damage caused by the Christchurch earthquake, 2011.

After the shaking finally stopped, they immediately ran to the ICU. “We needed to see that everyone was still attached to their equipment, and that everything was ok.” The gravity of what was happening was only just starting to sink in.

She didn’t know where her family was or if they were safe. Many of the phonelines had completely shut down due to overwhelming demand, so, for a few hours, Thora had no way to reach them. “I couldn’t really breathe. I had to get out of the hospital, I just needed some fresh air.“

She had no way of physically reaching her family either. “The tunnel in between Christchurch and Lyttelton was closed and I didn't know an alternative way to get there.”

With nowhere else to go, and knowing that the emergency department would be severely impacted by the carnage caused by the quake, Thora decided to head down to the ED floor. Because she was familiar with the department, having just finished a rotation there, she figured it was where she would be most useful.

When she arrived at the ED, the emergency physicians and nursing staff had already set up a meeting in the trauma room to consult disaster guidelines and prepare for the onslaught of injured patients.

Thora remembers, “They were really relaxed and structured in their approach. They already had a plan on how they would manage all the people that would be pouring in. It was comforting, in a way.”

Halfway through the meeting, there was a large aftershock. Everyone went silent and just stood there, waiting for the shaking to subside. Once it did, they continued planning.

After the meeting, Thora went outside to catch her breath. As she stood outside, she saw the first victim of the earthquakes arrive: a man in the back of a pickup truck.

“The people who brought him in kept shouting, ‘He needs a doctor! He needs a doctor!’”

A group of first responders rushed over to him, quickly determined his condition, and brought him into the department.

“She was having lunch in the tearoom, sitting opposite a fellow Icelandic doctor, when the earthquake struck. They both huddled under the table, hoping it would be solid enough to protect them. “We just looked at each other and were like, is this ever going to be over?” ”

She thought there would be more ambulances, but most people came in off the street, helped by friends or family, or by strangers. All the medical students were assigned to a cubicle, with another physician and nurse.

Thora helped a young girl who was badly injured. She had been sitting next to her brother when the earthquake hit. He had died in the wreckage. As she tried to suture together a cut on her hand, another aftershock struck. Thora couldn’t stop her hands from shaking.

After a few hours, the medical students were told they could leave. By this stage, Thora had gotten through to her mother and son, so knew they were safe, but she had no idea how she was going to get home through the ruined city.

One of the other medical students lived nearby, and said Thora could stay with her until things settled.

When they got to the medical student’s house, it had been largely reduced to rubble. All that remained was the living room, a perfectly intact kitchen and the back porch. Not knowing what else to do, they took a seat on the porch. “We had a few beers and tried to relax, but couldn’t.”

After the quake

Thora and her family left New Zealand days after the quake. “As soon as I landed in Iceland I was like, ‘Oh, I'm safe’. Logically it doesn't make sense because we have a lot of earthquakes here as well. But the mind isn't always logical.”

She had originally planned to focus on emergency medicine after her placement, but, after the earthquake, she was deterred from the unpredictable nature of EM.

A compulsory rural placement introduced Thora to rural medicine. She was fascinated by the broad range and severity of cases, and the cerebral challenge of practising medicine with such limited resources. She specialised in general medicine in 2017 and today works as a locum, travelling over the country.

“Just before they were about to call it, they felt a faint pulse – the patient was still hanging on. The patient was airlifted to hospital where she had induced therapeutic hypothermia. When she was woken up, miraculously she was completely fine. ”

Rural medicine also reintroduced her to the high-acuity cases she enjoyed treating, sparking an interest in the more extreme, complex cases that she had to see as a rural GP in areas with limited access to EDs.

“For the high-acuity cases it’s a love-hate relationship because you always hope for the low-acuity, but when high-acuity cases do happen, they’re often the most interesting and rewarding cases when it works out.”

One experience in particular cemented Thora’s interest in high-acuity care. She was working in a rural clinic when the local ambulance was called for a 27-year-old woman who was experiencing seizures. Thora was a junior doctor at the time and was sent out with a paramedic to assess the situation. It took them an hour to get there.

When they arrived, the 27-year-old had gone into cardiac arrest and her friends were performing CPR. “I was the only doctor on scene. We were doing the resuscitation for a while. We put her into the ambulance and took her to the nearest airport to be airlifted to hospital.”

The drive was another half-hour. An anaesthetist met them on the way to the airport and they discussed stopping the resuscitation effort once they arrived. At that point, they had been trying to resuscitate her for 50 minutes. Thora said, “We never considered stopping – it just never occurred to us.”

Just before they were about to call it, as they were transporting the patient from the ambulance to the air mattress, they felt a faint pulse – she was still hanging on.

One of the clinics Dr Thora works at in Iceland.

The patient was airlifted to hospital and had induced therapeutic hypothermia. When she was woken up she was, miraculously, completely fine.

“Even now I find it really hard to stop a resuscitation,” said Thora, “because I always remember that I did a 50-minute resuscitation and it worked out.”

Twelve years after the Christchurch earthquake, Thora is now completing the Emergency Medicine Diploma. “When I chose rural medicine, it just felt like the safer option. But now, I feel ready for the craziness again.”

She loves being exposed to difficult situations. Managing high-stakes resuscitations like with the 27-year-old reinforced, for her, that she had the skills, and attitude, required to excel. “I wanted to do the Diploma to improve my skills in that area, because that’s the medicine I enjoy the most.”

Thora is hoping to use this degree to shift to emergency care in rural settings. She hopes to do a six-month rotation in rural Australia.

“I just love going to new places and meeting new people. Every place I go to has different resources and different mindsets that I can learn from. It’s the best!”