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We ended the night, in the early morning. All kinky implications aside. Ben and I crumpled into the grass outside the hanger gazing up at the stars hoping to catch a glimpse of part of the meteor showers. The night was cool, the sky clear but distant with the airport lights. We found the most protected area we could in the shadow of the fuel truck. Lying shoulder to shoulder quietly discussing the night.

I keep kidding him, asking if he really wants to go to CRNA school. The view out of my office window is far superior according to him. Until last night all he had to base that on was photos. Staring up at the sky, he now completely understood why I do what I do.

Ben—post Cherry Popping

The call came in around 10 p.m. He showed up at the hanger to have dinner and ended up sitting next to me at 2,500 feet, circling an accident scene.

“19 year old male, pin-in with head and lower extremity injury,” was all we knew.

I broke into the RSI (rapid sequence intubation) kit, reviewing the cocktail and doses for sedation and paralyzation with the Flight Physician. Life is so much easier when I plop the drug bag open and can simply begin pushing drugs.

Fentanyl, Etomidate, Lidocaine, Succ, Norcuron. I handed Ben syringes and drug vials. He knew I was going to use his experience as a critical care nurse. I just don’t think he believed it would be that quickly. Labels on syringes. Order and doses written on my leg tape so I wouldn’t forget. I don’t remember if I don’t see it.

The landing zone wasn’t well defined. It is difficult to see flashlights marking the LZ when the rest of the local area is littered with fire, ambulance and police vehicles blinking and flashing. Ben had a grin from ear to ear. He had a better view out the window than I did. His heel kept bouncing in anticipation and excitement.

I handed Ben the portable pulse ox. It gave him a task to focus on, and one less thing for me to do. We exited the aircraft almost attached at the hip. I didn’t want to have to worry about him getting too far.

There are two types of scene calls. During the first, we take an active part in the extrication and packaging of the patient. We arrive early enough to help with the dirty work. The second type of scene flight we meet the medics and patient in the back of the ambulance. Normally, the ABC’s (airway, breathing and circulation) have been addressed. Airway controlled, bleeding stopped and IV’s established. That was the case with this flight.

Damn. I love a good extrication.

Regardless, Ben, the doc and I jumped in the back of the ambulance and were instantly accosted with a cussing, spitting drunk who was appropriately secured to a backboard, as much for his protection as ours.

Damn. I hate a bad drunk.

Nothing a bit of Fentanyl and Versed can’t cure. Especially since he was spitting blood. His face took the brunt of the collision.

Ben fought to get the pulse ox on and won. 99% on room air. Just what I wanted to see. 14 gauge in the crook of his arm. 16 gauge IV in his forearm. It is good to be a young trauma patient. Those garden hose veins are what I like to have to work with.

Well…apparently the Fentanyl and Versed worked a bit too well. We were going to intubate anyways.

RSI drugs ready, suction on, breathing tube and intubation equipment laid out in chaotic order. Patient’s breathing assisted by BVM (bag, valve mask).

“Lidocaine in at 2223. Pulse OX 99%.”

Without communication, doing an intubation can be tragic.

“Okay, ready for the rest,” the doc says.

I push the rest of the drugs, paralyzing and sedating the patient. He gets the tube, slick as can be. Ben spent the entire time on the patient’s right searching for equipment and being exposed to the art of intubation in the field.

We secured the tube after verifying placement by listening to lung sounds, using an end tidal CO2 detector, and listening over the epigastric area. With his airway secure, I finished doing my assessment. Nothing at the chest, belly soft, pelvis stable and limbs intact. Pulses were amazingly good.

I tossed Ben an OG (oral-gastric) tube. Nothing like sucking out a belly full of booze, but an important precaution nonetheless. Warned him that I was gonna use him! It is one thing to do nursing procedures in a controlled environment. It is another thing entirely to do them in the back of an ambulance, or in the dark by flashlight with a smashed up car teetering precariously above you.

The remainder of the flight went without incident. His vitals remained stable, but I think Ben was in Sinus Tach for at least the next 3 hours.
Hopefully this kid will be one of the lucky ones.

Wore him out! Us post-flight duty
on the Amtrak headed to Memphis

My mom has told me that they should use me as the basis for an action figure. Okay, maybe not action figure but something along the lines of “Roller blade Barbie, Beach Barbie, Teacher Barbie.”

You get the idea.

In the past year of being a flight nurse I have not had the opportunity to actually catch a glimpse of myself at work. Last night, Ben, who was doing a ride along with me, snuck a few photos in the trauma bay from his Treo.

TRAUMA BAY
Pilot in left foreground, me in baseball cap over his right shoulder, Flight Doc to my right, Trauma Physician in scrubs.

3 INCH TAPE
Me standing at the foot of the stretcher reading off the list of drugs I administered, as well as their doses and times. I don’t function without a hunk of silk tape stuck to my leg. The trauma team is in the background cutting the rest of the patient’s clothes and beginning their assessment.

BP CUFF
The last flight I almost lost our reusable BP cuff in the trauma bay. . . I had a grip on it this time!

One of the lessons I was taught while early in my career, was to trust the knowledge of family members who care for a loved one who is handicapped. While in my Pediatric ICU rotation at CHOP (Children’s Hospital of Philadelphia), my preceptor showed me over and over that families, mothers in particular, knew their children’s needs, and how to care for them better than any nurse ever could.

These children had disorders and birth defects which affected multiple body systems. They needed trach care, feeds through G-Tubes and medicines I had never heard of. There were contraptions, tubes and procedures I had never been exposed to.

Her lesson: “Ask, ask, ask the parents. They know more than you do and are more than willing to teach you.”

In fact, these parents were almost palpably relieved when I didn’t go in as many nurses must have, with a sense of superiority, flaunting a nursing degree.

This lesson came back to me on a recent flight. A small child had multiple birth defects and a long surgical and medical history. She was incredibly sick and needed us to get her to the children’s hospital in our area. I spent most of the time before take off asking her specifics like, what was the best way to bolus fluids through her g-tube? What the most effective way to suction her was and how she normally responded to each of things? I had her mother help me with her car seat and in between took the time to talk to the baby: she shares a name with one of my nieces.

Never once was this angel of a mom irritated with my questions. She had to trust me with the life of her child whom she has dedicated every waking moment to giving extraordinary amounts of love and care to. I was taking that control from her, when she knows no one knows her child like she does.

It is no wonder that nurses are the most trusted profession year after year. We have to be.

Just remember, always ask, ask, ask.