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toed boots. We pulled off our helmets. My partner was one
of my favorite people to work with: smart, funny, the sort of
clinician who could size up a situation and do exactly what was
necessary, no more, no less. He was tall and muscled, and you d
think he was in his twenties if he didn t have some gray. I was his
opposite, short and dark. Ancient pregnancy flab straining the
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66 Jennifer Culkin
long zipper of my flight suit. We each gave the kids a parade-
queen wave. A couple of them waved back.
Eventually a volunteer with a radio informed us it would be
a while before our patient arrived. Nothing about it sounded
good. Our pilot told the Little League coaches to continue the
game until we had to take off again.
Our ground time was more than half an hour, I found
later, when I wrote up the flight from the chicken scratches
I d scribbled on two-inch-wide white tape stuck to the Nomex
covering my right thigh. A form of eternity. We aim for ten
minutes at the most from the time we touch down until the
time we lift off again, trying to take advantage of that golden
hour after trauma the brief window in which a patient can
be saved if definitive treatment is provided. I kicked at the
mown grass as we waited, shrugging my shoulders, watching
baseball s small successes the base hit, the one perfect pitch
and its small defeats the big whiff, the muffed catch.
We could hear the siren for a couple of minutes before we
saw the rig. But at last it kicked up dust in the gravel lot next
to the baseball field, its flashing lights washed out in the strong
spring sunlight. It was not our first flight of the day, and it was
my partner s turn to take report on the patient. Officially, that
means he was in charge of the patient s care, though in practice
it s almost always collaborative. My turn to package the patient
up for transport. He preceded me into the patient bay, taking
the big step up through the rig s back door.
It was cooler inside, and dim after the brightness of the
afternoon. Backboarded on the stretcher lay a seventeen-year-
old boy, a boy the same age as my son was then. He was tall, had
straight, dark blond hair. If he was bloody, as he must certainly
have been, my memory has filtered that out. I would have ex-
pected abrasions and cuts, random splashes of blood, even frac-
tures. I tend to remember only what was striking or pertinent.
CPR was in progress; that was pertinent. The paramedic
A Final Arc of Sky 67
held up a hand, signaling the emergency medical technician to
stop CPR. I put two fingers at the top of the boy s thigh, in the
crease of his groin. With CPR, there had been a faint femoral
pulse, which meant compressions were effective. Without it,
nothing. And when you took away the electrical/mechanical
noise of chest compressions, there wasn t so much as a blip on
the monitor. A flat line asystole.
Asystole in this situation is a death knell. It means the heart
is so starved for substrates blood, oxygen, glucose that it
can t beat, not even a few times a minute. It can t even quiver.
Head-on collision, estimated speed fifty, medium-sized
pickup versus a subcompact, about fifty minutes ago now, the
paramedic told us as the EMT resumed compressions. With
one hand, he bagged breaths into the boy through an endo-
tracheal tube, and with the other, he shot the contents of an
epinephrine syringe, a single dose of a potent cardiac stimulant
made for cardiac-arrest situations like this one, into the boy s IV.
Patient was the driver of the subcompact, and it was demol-
ished on fire department arrival he was half pinned in the car,
half on the street. Had a carotid pulse at first, but lost it almost
immediately. Pupils initially reactive, now fixed and dilated. We
got an IV this was no small feat in a patient without a blood
pressure who was bleeding out from internal injuries and he s
had three liters of saline. CPR has been in progress twenty min-
utes. This is our third milligram of epi, he said, gesturing to
the syringe with his chin, and we ve given two milligrams of
atropine. There was a fatality in the accident: the driver of the
pickup was dead at the scene.
It s gonna be two fatalities, I thought as I worked at putting
our equipment on the patient. I knew without asking that my
partner was on the same page. He shot me a glance that con-
firmed my thinking as he listened with a stethoscope to the boy s
chest.
So, good breath sounds bilaterally as you bag him, but
68 Jennifer Culkin
CPR for twenty minutes, three liters of fluid, three doses of epi,
pupils fixed and dilated, asystole, he said, summing up. Do
you want us to take him?
It would have been completely proper, and perhaps easier
for the family in the long run, to cease efforts. But the boy was
seventeen, and we were out here on a baseball field miles from
anywhere with the crack of a bat and the muffled cheers of Little
League filtering into the rarefied air of the rig.
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