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Chapter 1

Lifting Off

I had the fear. The all-encompassing fear. That sickening, sinking feeling that the events unfurling before me were barreling rapidly out of my control. At any moment, the beeper would signal the end of this charade, this idea I might someday join the ranks of the best of the best, the elite of the nursing world. Flight nurses.

The helicopter was quiet for now. Morning preflight was done, and Harry had gone back into quarters to start the day's paperwork. The smell of Jet A fuel wafted through the hot July air. Our trauma bag was safely secured with the seat belt on the Day-Glo orange litter, and the tubing for the blood pressure monitor was coiled and stowed so it would be ready to use with one tug. The EKG patches, already attached to the cable, were set to be slapped onto our patient's chest. We were ready for anything. The only thing missing was some unfortunate soul who required our services. For a brief moment, I had a fantasy that maybe I could do this job after all.

Suddenly the pager vibrated on my belt. My stomach felt as if I were on the roller coaster from hell and my sweating hands shook as I grabbed the beeper, pushed buttons randomly and inadvertently deleted the message. My first act, and I had screwed it up.

My career as a flight nurse was off to an inauspicious start.

Harry, one of my mentors during training and my partner that first day, came loping out to the helicopter with Pete, our pilot, running close behind. "All right, let's go," he yelled as he swung into the front seat and effortlessly locked in with the four-point belt. "Ya all set?" he asked, reaching for the maps. "Harry, I'm not ready. I erased everything on my pager. I don't even know where we're going."

"Now, just relax and take a deep breath," Harry said as I panicked. "I'm right here, and I'll help you. We're going to Santa Cruz County on Skyline Boulevard for a motorcycle accident." Pete cranked up the two jet engines, drowning out any further conversation until the intercom was powered up.

As we lifted off I froze, entirely forgetting everything I had learned in our radio class. Despite a week devoted to learning the system we used in the helicopter, and the various county frequencies, it was all now a complete blank. The nurses had four different radios to manage and the pilot three—seven frequencies that might be blaring all at the same time.

I squinted down at the radio console's millions of small buttons and switches. Harry reached over and switched my station to the dispatch radio to let them know of our liftoff time and ETA to the scene. He smiled and patted my hand.

There is a specialized language used on the radios, and I certainly hadn't mastered it. I
tentatively keyed up the mike to our dispatch. "Uh, CALSTAR One, this is CALSTAR, uh, base. I mean, this is CALSTAR One. We, uh, just took off—uh, lifted off from Concord."

There was a slight pause as dispatch considered my garbled message, and I could hear snickering in the background. "CALSTAR One, we are the base. You are the helicopter. And you are responding to a motorcycle accident on Skyline Boulevard. Your map coordinates are Thomas Brothers, page 64, B4. Your ground contact will be Captain 61 on fire white, frequency 154.280. Do you have an ETA?"

I was unsuccessfully trying to write down all of this essential information when I realized I had no idea what our ETA might be. Keying up the transmit button instead of the intercom button, I said, "Pete, they want to know what our ETA is."

Dispatch responded wryly. "CALSTAR One, you hit transmit instead of intercom."

"Oh, sorry."

Pete was up front, giggling. "Janice, relax. It's going to be sixteen minutes if the coordinates I have are correct."

Now I had to do my arithmetic. Let's see. It was 11:12. In sixteen minutes it would be, well, uh ...

Harry again came to my rescue. "Base, CALSTAR One. We have an ETA of 11:28. Copy map coordinates and ground frequency. Confirm Valley Medical is open and willing to accept?"

"Open and accepting," base responded.

The first part of the flight hadn't gone well, but I was determined to get something right. As we approached the scene, I carefully dialed in our ground frequency and rehearsed the dialogue in my mind. I confidently switched off from the dispatch radio and onto the ground unit. "Captain 61, this is CALSTAR. We have an ETA of 11:28. Please let us know when you have a visual on us." Quite pleased with myself, I sat back and awaited their response.

"CALSTAR One, Captain 61. Your landing zone is going to be—"

Abruptly, his radio transmission was drowned out by traffic on two other concurrently running radios. One was a paramedic giving a lazy radio report to another hospital: "... and we have him on four liters of oxygen, and are giving an Allupent nebulizer..." This traffic competed with the comm radio, which was also blaring: "Cherokee 654 Bravo, turn into left downwind after departure. Traffic in the pattern is a Cessna at your two o'clock."

I reached over to switch off the distracting radios, and succeeding in turning them all off. Including our ground contact. Desperation set in. "Harry, help me. I just turned off all the radios back here," I pleaded.

He reached over and flipped up the correct switch. "You're doing fine," he lied. "Takes a while to learn to work the mighty Wurlitzer. Now all you need to do is get our landing zone instructions.
Piece of cake."

Despite my ineptitude, I did manage to get our LZ information from the fire department, who were already on scene. We were to land in a field about one mile away from the actual incident, as there were no safe LZs nearby. A fire truck was waiting to transport us to the accident. Pete circled the area and gently settled us onto the ground. "You're cleared out," he said. As I scrambled out of the helicopter, I remembered to buckle my seat belt behind me so I could find it quickly when we returned with the patient. Harry grabbed the trauma bag and together we scrambled up into the cab of the fire truck.

"Hey," Harry greeted the firefighters. "How's it going?"

"It's pretty crazy up here," one replied. "We now have two separate accidents less than a mile apart. You guys are getting the MCA patient, who planted his face into the back of a parked van while he was going about seventy miles an hour. No helmet—he's pretty messy. The ambulance that was supposed to respond to this accident had to stop up the road for the other one. I don't know if a second ambulance can get to this one."

I was only vaguely listening to this conversation. The fire truck ride was a hoot, and I was grinning like an idiot as we bounced along the rutted road, reflecting on what an enormously cool job this was. As we turned onto Skyline, the firefighter switched on the lights and siren to get through the backed-up traffic. I saw a sign that indicated we were leaving Santa Cruz County and entering San Mateo.

Harry groaned. "So this incident is actually in San Mateo, huh?"

"Yup," the firefighter said. I vaguely wondered what difference that made. "Well, here we are."

Out the window, a group of firefighters huddled around a supine figure on a backboard. We climbed out of the huge truck and trotted over to our patient. "Oh,
Jesus," I said softly. This poor man wasn't recognizable as human. His head was a jagged mass of bone and tissue; his entire face was disconnected from his skull. Facial fractures are graded on the LaForte scale from one to four, depending how much of the face is still connected. This guy had a LaForte fifteen. One of the firefighters was vainly attempting to assist his breathing manually with a bag and mask, but I could tell it wasn't working well. Every time he gave the patient a breath, air would spurt out through holes in his forehead.

Harry asked me to take over the bagging, and the firefighter stood up and handed me the mask. Feeling a little squeamish, I knelt down to resume the imposs