Flight for Your Life
You’re hurt. If you don’t get to an emergency room in a hurry, you’ll die. What you need is a medical helicopter to take you on the …
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THE FIRST TIME I MET FLIGHT nurse Mindy Nichols, she told me a series of bizarre stories about patients she can’t forget. One was about a woman who had placed a turnip inside her vagina and forgotten about it. It was discovered when she called EMS suffering from abdominal pains; it had sprouted roots. These kinds of stories are endemic to the culture of emergency rooms.
Another flight nurse said that men on the edge of consciousness sometimes lose their inhibitions. “I had one guy who begged me to let him lick my fingers all the way to the hospital,” the nurse recalled. “I told him, ‘I don’t care how hurt you are, you can’t lick my fingers.’ ” In Houston I heard about a man who came in with a bottle of Brut cologne stuck where the sun does not shine.
What kind of people would consign themselves to this sort of work culture? Flight crews have the same sensibilities as firemen, police officers, and ground paramedics, with the added intensity of speed and flight. They are goal-oriented excitement addicts who are coolest in life-and-death situations.
When an EMS helicopter lifts off, three distinct worlds converge in 220 cubic feet of space: those of nurses, paramedics, and pilots. What attracts all three to EMS flying is autonomy—the chance to confront the unexpected and have the authority to act alone. “Out in the field, we don’t have time to telephone a doctor and say, ‘Mother, may I?’ ” said Dallas flight nurse Sandy Willis. “We just haul ass and do what needs to be done.” Flight paramedics are accustomed to working in the uncontrolled environment of the streets. What they like about flying is that in helicopters they get to do more invasive and complicated procedures than in regular ambulances. Pilots like flying helicopters because no mission is the same. “It’s a lot different than flying in Vietnam,” said Houston pilot Glenn Storey. “I haven’t been shot at lately, but I have landed in the middle of the freeway during rush hour.”
The competition for flight jobs is intense, even though flight nurses are paid no more than emergency room nurses, and flight paramedics earn no more than ground paramedics. A paramedic earns about $26,300 a year, while a flight nurse, who has a higher level of medical training, earns about $34,000. The wage difference has caused tension and turf battles in some programs, particularly in Austin. When Star Flight first started in 1985, the helicopter flew with two paramedics and a pilot, but no nurses. Today some paramedics continue to regard nurses as unnecessary. “What’s the difference between a helicopter and a flight nurse?” goes a joke popular in Austin paramedic circles. Answer: The helicopter eventually stops whining.
The gallows humor and the day-to-day grousing are ways of coping with the stress of the job. Not only do flight crews see horror and brutality on a daily basis, but they also confront the physical danger of flying. Houston flight nurse Rosie Waindel survived a crash in April 1989, when her helicopter’s tail rotor hit the Hermann Hospital parking garage on takeoff. All three members of the crew survived, but Rosie was in the hospital for one month. She couldn’t walk for two and a half months because of her injuries. Today she works with steel rods in her back. I asked her why she returned to flying. “I worked real hard to get this job,” she told me. “I wasn’t going to let anything take it from me.”
Red Duke’s theory is that flight crews are like all emergency room personnel: foolish crusaders who are addicted to cheating death. “They seek out these jobs because of who they are to begin with,” he said, “and then this environment we operate in keeps us all hooked.” The long hours create a group culture. Most nurses and paramedics work 12-hour or 24-hour shifts two or three times a week. The atmosphere in crew headquarters is jovial, even familial. In Dallas one pilot is called Papa Smurf. In Austin a blond paramedic is called Old Yeller. There are nicknames as well for types of trauma. “Good trauma” describes the most critically injured patients. Amputations are good trauma. So are multiple gunshot wounds, especially those involving unusual guns like Uzis. “Junk calls” are false alarms.
I experienced a junk call in late December when I flew with Star Flight. The call from the 911 police dispatcher came in at 5 p.m. All we knew was that two children were missing near a rain-swollen creek. I felt the rush of adrenaline as we lifted off from Brackenridge Hospital and floated over the state capitol. Beside me, Pauline Van Meurs, the paramedic, was sorting through rescue ropes while Lourdes Maier, the flight nurse, consulted a map and talked to the dispatcher by radio. I sat still in my seat, sinking inside myself to prepare for the sight of two injured, perhaps even dead, children. As we made our way north, I heard the voice of the dispatcher inside my helmet: “Cancel Star Flight 1.” The children had been found. They hadn’t been lost in the creek at all; they were visiting a friend’s house without their mother’s permission. “I hope they get a whippin’,” I was shocked to hear myself say.
I realized I was becoming what flight crews call a trauma junkie, one of those people who figure that if disaster is going to happen, it might as well happen on their shift. The worst part of any shift is the wait. Hours—sometimes whole days—pass between calls. When the weather is bad, as it was for days and nights on end in December, helicopters are grounded and injured people die. When fog rolls in, the helicopter is useless. In some programs, flight nurses help out in emergency rooms during slow times, but usually all three members of the crew sit and wait, trying to magically conjure up calls. Some eat dinner, believing the moment they take the first bite, a call will come in. Some start a good book. Others pop a movie in the VCR. In Austin a particular favorite is Dr. Strangelove. When the base commander, played by George C. Scott, rants about the Communists robbing us of “all our precious bodily fluids,” the waiting members of the crew enjoyed an insider’s laugh. For them, precious bodily fluids are not an abstract idea.
But I found out that the best way to provoke a call is to go to sleep.
WAKE UP!” SAID MINDY NICHOLS. “We’re going to Uvalde.” It was 12:30 a.m. and I was thirty minutes into an uneasy sleep on the floor of AirLife headquarters at Baptist Memorial Hospital in San Antonio. As we race-walked to the helicopter, Mindy explained that we were going after a 55-year-old Hispanic male suffering from kidney failure. This was exactly the kind of patient AirLife was meant to transport: Without the helicopter, he might not survive the seventy-mile ambulance ride from a spoke hospital in Uvalde to a hub hospital in San Antonio.
It took only a minute or two for pilot John Fluke, paramedic Eric Epley, Mindy, and me to get buckled into the Bell 412 and prepare for lift-off. The three of them were suddenly very serious, completely engrossed in the details of their work. As the helicopter flew first over freeways, then over dark pastureland, I felt the physical rush of power that comes from running toward, not away from, death.
Thirty-three minutes after we took off, the helicopter hovered over a grassy spot near the Uvalde hospital. By now it was just past one in the morning, and I was suprised to see about thirty EMS volunteers on the ground, lighting a landing area for the helicopter. I watched them brace themselves against the wind. All of them presumably had paying jobs to get up for the next morning, yet each had gotten out of bed in the middle of the night to do this work for free. I hurried off the helicopter to ask them why. “Just crazy,” replied one who had positioned himself near the helicopter’s side door. “But you never know when somebody in your own family is going to need this kind of help. If I help tonight, maybe somebody else will help out when it’s my turn.”
By then Mindy and Eric had hurried into the emergency room wearing their shiny blue fire-resistant flight suits and carrying two armloads of intensive-care equipment. They looked like the cavalry to the harried nurse who rushed toward them and said, “Thank heaven you’re here. You’re looking at the only pair of hands in the ER tonight.”
Mindy turned her attention to the patient. Pedro Alvarado was lying on a table, groaning. “Does he speak English?” asked Mindy. “Not much,” replied Pedro’s wife. Their 22-year-old son stepped forward. He was wearing a black gimme cap that read, “Till Death Do Us Part,” but no one seemed to notice the irony.
“It’s going to be cold, Pedro,” Eric said, as he wheeled Pedro out of the hospital into the night air. “Que paso?” asked Eric, but Pedro did not answer. By then he was unconscious. I had seen other paramedics around the state talking to unconscious patients. It’s a way of maintaining a human connection. Besides, most flight crews are aware of studies showing that even the unresponsive patients hear and remember what was said to them by emergency personnel. “I talk to all of them now,” one Austin paramedic told me, “especially the dead ones.”
Pedro was in danger of having a heart attack. Inside the helicopter, Eric hooked him up to a machine that monitored his heartbeat and the level of oxygen in the blood. It was eerie to watch Pedro’s heart register a beat on the tiny computer screen overhead. The rhythm of the beeps was all wrong. His body was tangled with IV’s, and his head was held still in a brace. His face was brutally moist—he seemed to be leaking from his eyes and mouth. Occasionally his eyes opened, and I looked inside to the forbidden world of fear and death.
The scene inside the helicopter was luminous. Eric and Mindy were detached and aloof, a couple of well-trained technocrats instinctively working at top speed. Twenty minutes into the flight, Pedro breathed easier. His heartbeat was still irregular, but his blood pressure stabilized. “He’s doing better,” said Eric.
Inside the intensive care unit at Humana Hospital in San Antonio, there were ten times the number of nurses and doctors we’d left behind in Uvalde. The now-familiar ritual began. Mindy gave her report while Humana’s team started their own round of tests. One of the nurses stroked Pedro’s arm while speaking to him in Spanish. The rhythm seemed to revive him. Pedro awoke briefly to complain of being cold.
He was going to make it. It was time to think about going to sleep. I asked Mindy how she copes with the highs and lows of her job, saving some lives and losing others. They all have their ways—some do t’ai chi, some bake bread, others try long-distance running—but not one of them likes to talk about it. “The way I do this job,” said Mindy finally, “is to be grateful for the ones we save.”
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