Ladies and gentlemen, we will be landing at San Francisco International Airport in just a few minutes. Kindly pass any glasses to the aisle for collection, and return your seats and tables to their original positions.”
I closed my eyes and said a silent prayer of thanks. The AAMES (Association of Air Medical Emergency Services) conference had been the hardest four days I had endured in years. I felt my abdomen, expecting to find my liver edging close to my navel. If I never saw another bottle of tequila again, it would be too soon. I desperately wanted to get home, hug Mark and Roscoe, take a long shower, and sleep in my own bed.
Rose, who was sitting on the other side of the aisle, woke up and started gathering her luggage. She leaned over to me. “This has been quite the field trip, huh? Hey, we’re working together the day after tomorrow. Think you’ll be recovered by then?”
“Doubt it,” I answered. “I’m sick of looking at you.” We grinned at each other and she squeezed my hand.
I glanced over at Andy, who was rummaging through his bag. Like mine, it was overflowing with T-shirts and cheap souvenirs we had picked up at the conference. “Hey, Janice, do you know what I did with my beeper?” he asked. “I can’t find it.”
“I have it, remember? I took it away from you on the way to Tampa. Guess you can have it back now.” I pawed through my own bag and pulled out a smelly shirt I had been wearing the previous night. It was heavy with more than 150 pins, which I had collected from various flight programs around the country.
“Janice, you are such a pin slut,” Andy said, shaking his head.
“I worked hard for those pins,” I responded. “Oh, here’s your beeper. It’s official. The party’s over. We’re going to have to pretend we’re adults again.”
We landed and disembarked. As we were trudging through the baggage claim, Andy’s beeper went off. “I can’t believe this,” he muttered. “We haven’t been on the ground more than fifteen minutes. Would you guys get my bag for me? I’ll meet you at the carousel.” He headed off for a bank of phones.
Rose looked over at me and smiled. “Welcome home.”
The 1992 AAMES conference was in Tampa, and I was up before dawn to get ready for the flight. As I grabbed my bag and headed for the door, I realized I had forgotten to kiss Mark goodbye. I made a quick about face and ran into the bedroom, where he was still wrapped in the gentle arms of sleep. I leaned over and whispered in his ear, “Bye, honey. I’m off to AAMES. I’ll call you with the hotel’s phone number when I get there. My flight information is on the dining room table. Love you.”
Mark curled himself deeper into the covers. “Don’t drink too much,” he mumbled. “And bring me back lots of loot, OK?”
I scooped up Roscoe and gave him a quick kiss. “You two bachelors behave yourselves while I’m gone.”
Attending AAMES is a rite of passage—you’re not truly a flight nurse until you’ve been initiated by spending a full week too hung over to sit up. Now the conferences have become marginally respectable, but in the early days of helicopter medicine, they were really nothing more than drinkfests. This was my third one, and I’d be attending with Andy and Rose. It didn’t take us long to get into the spirit—we began in the air with a breakfast of complimentary Bloody Marys. “You know, we’re already in trouble,” I said. “God help us.”
We arrived at Tampa International Airport at the same time as a contingent from Pennsylvania, a group of hard-partying flight nurses we knew well. There was much squealing, chattering and hugging as we caught up. All of us would be staying at a cut-rate hotel across the street from the Hyatt, the official lodgings for the conference. We had found in previous years that a cheap hotel’s management was more tolerant of our late-night activities than the more respectable chains. We piled into three taxis, seven bodies in each, and headed for the city.
Forty-five minutes later, we were in the lobby of the Surf Hotel. As we approached the desk, the manager, who had been quietly reading the paper, looked up with alarm. He regarded us suspiciously as we checked in. Frank, one of the Pennsylvania nurses, popped open a beer from his portable cooler.
“What convention are you with?” he asked. “Hey, you over there. No open containers in the lobby. Yeah, I’m talking to you. You can buy booze in the bar, but ya can’t bring your own in here.”
Andy, always the diplomat, tried to take control of the situation. “Glad to meet you, sir. I’m the chief flight nurse at California Shock/Trauma Air Rescue. We’re with the aeromedical conference.” He turned to Frank. “Now, Frank, you know better than that. The gentleman’s right. Put that away. We want to make a good impression, don’t we?” He turned back to the manager and unleashed a dazzling smile. “Don’t worry, we’re professionals.”
Soon after, we were pulling chairs around the pool and Andy headed to the bar for the first round. “Hey!” a voice yelled from the other side of the pool. “Andy! Janice! Rose! Over here!” It was George and Skip, two flight nurses from a program in North Carolina called MAMA, an acronym for their sponsoring hospital. Their exploits at AAMES were legendary, and we affectionately referred to them as the MAMA’s Boys. As we pulled up our towels and prepared to join them, the Pennsylvanians started to file in. Frank was grinning and hauling a fifth of tequila. I knew it was over.
The rest of the evening was more or less a fog. I vaguely remember all of us being thrown out of the pool at 2:00 a.m. and trying to sneak into the Hyatt’s hot tub around three. Another group of flight nurses from North Dakota joined us in our hotel room around four, along with a cold case of beer. The next thing I remember was the shrill buzz of the alarm clock at 7:00 a.m.
I looked around the room. Rosie was lying on the other bed, fully dressed but looking rather wrinkled. Andy lay on the floor, snoring and curled up in my bedspread. The MAMA’s Boys were lying in a heap of wet towels. Rose opened her eyes and stared blearily at me. “God, what a night,” she whispered. “Am I still alive?”
“I don’t know about you,” I said, “but I wish I was dead.” I stumbled over Andy as I headed for the showers. “Oops, sorry. Make way, coming through.” Andy sat up carefully, holding his head.
“Whose shorts are these?” he asked, looking down at the soggy swim trunks he was wearing.
“They’re Skip’s. You didn’t have any trunks to wear in the hot tub last night, so he gave you his. You should appreciate that—he was wearing them at the time.”
I leaned against the shower wall, praying the hot water would wash away the toxins. There was a class at eight that morning that had us all thrilled—at least it had sounded thrilling the day before. A famous professor of anatomy was scheduled to dissect a cadaver in one of the huge meeting rooms. As a freshman studying anatomy in college, I had studiously avoided even looking at cadavers because of squeamishness. Obviously I had gotten over this hurdle, and I was eager to get a review of the actual structures we so frequently dealt with in the field.
Now it seemed like a really bad idea. I could barely stand up, my stomach was in utter turmoil, and my head felt like it would explode with each heartbeat. I wasn’t even sure I could walk to the convention center, let alone watch a postmortem dissection. “Please, somebody just shoot me now,” I whispered to myself, closing my eyes and letting the water wash over my face.
After a breakfast of hot tea and dry toast, we trudged over to the lecture through rush-hour congestion. The exhaust fumes were overwhelming, and the jackhammers from a nearby construction site drilled into my skull. Despite a large-brimmed hat and dark glasses, I cringed at the bright sunlight.
The convention center was a cavernous affair divided into many large lecture halls. We milled around aimlessly, unsure of where the class was to be held. Then we caught a whiff of what could only be cadaver. There is a unique odor associated with the anatomy lab—formaldehyde mixed with the smell of a dead body—that defies description. Once that smell has registered, it is locked forever into the memory banks. There is no smell quite as repulsive in this world.
“You know,” Rose said as we found the doorway, “maybe we shouldn’t hog all the good seats in front.” Andy and I nodded as we sidled into the room, trying not to look at the dissection table.
We sat down just as the professor strode into the room, resplendent in his flowing white lab coat. “Good morning!” he boomed into the microphone, causing several of my cohorts to clutch their foreheads. The professor continued, unaware of the pain he was inflicting. “It is a pleasure to be teaching such an accomplished group of medical professionals. I realize many of you have not returned to the anatomy lab since your initial training. I hope today’s lecture will be informative and stimulating.” As he spoke, he whipped off the plastic that covered the body. Television monitors revealed a close-up view of the wizened cadaver’s face and neck, with its mouth slightly ajar. We all recoiled in horror. Not one of our group was prepared to witness such a sight.
The professor continued, oblivious to our reaction. “Today, we will start with the dissection of the neck and trachea, as the emergency management of the airway is a top priority for this group.” He made a large incision and began to busily saw away, and soon he had removed a large section of the trachea, including the larynx. He raised it up as if it were a trophy. Then he held the larynx to the camera as he reviewed the various structures. Giant vocal cords loomed in the monitors.
My stomach was churning, but I tried to concentrate. If I had gone through the trouble of getting here, I thought, I might as well learn something. The professor continued to deftly fillet the neck, describing structures as he cut. I turned to Rose, who was intently studying her shoes. “Rosie, are you OK?” I whispered.
“Just fine,” she whispered back, still staring at the ground.
Our lecturer, now having completely macerated the neck, turned his attention to the chest. Brandishing a sternal saw, he applied it to the thorax with great enthusiasm. This was followed by a gleeful attack on the rib cage with huge rib cutters. The noises from the front sounded as if he were squashing bullfrogs, and I felt my head starting to swim. Andy had beads of sweat on his face while Rosie continued to stare steadily at the floor.
But the good doctor was not yet done. He proceeded to identify and rip out all the major structures in the thorax, explaining the various body parts in detail. The television camera was now trained on an empty chest cavity, and unmentionable fluids dripped down the inner wall. I was sure I couldn’t stand much more.
After the discussion of the thorax was complete, our professor paused, building dramatic tension. “And now,” he boomed, “I would like to present you with the most fascinating aspect of human anatomy.” Again he paused as he grappled with the skull. “I present you with…the human brain.” With a flourish he pulled out the glistening, dripping gray mass by the brainstem and held it aloft.
I felt the room spin and I lunged for an exit. I couldn’t breathe. My stomach was in my throat, and I needed to find a bathroom in a hurry. It was all I could do to stagger down the hall. Thankfully, there was a bathroom next door, and I crawled into a booth, retching. On either side, I could hear other occupants performing the same task. I sank to the floor, mortified. How could a simple dissection have such devastating effects? After all, we saw a lot worse than that in our daily work.
I couldn’t face my colleagues and, after getting cleaned up, I decided to return to the hotel room and crawl back into bed. I slipped out the door, hoping no one would see me.
To my surprise, our entourage was milling around in the lobby when I got back to the hotel. Suddenly Frank appeared, yelling, “Hey, they’re giving away free beer out here!” Someone dragged me out and put a bottle in my hand. I glanced at it and realized to struggle was useless. I took a tentative sip.
And thus began another day at AAMES.
Now we were back in San Francisco, and the sound of Andy’s beeper had hauled us into reality. Andy returned from the phones with a dark scowl on his face. “What’s wrong?” I asked. “Is everything OK at home?”
“Oh, home is fine. But CALSTAR isn’t. While we’ve been off pickling ourselves, all hell has broken loose. Carrie’s father-in-law had emergency surgery, and she had to go home to help. That left the helicopter with only a skeleton crew, and everybody’s been working thirty-six-hour shifts to keep it covered. Now Mike’s sick, and there’s nobody to work tomorrow.” Nobody except us. There was only one possible solution: Rose would work a thirty-six-hour shift starting that night, and I would work a thirty-six starting the next morning. Of course, Mark would be less than thrilled to have me away for another day and a half, but that was the only way to keep the helicopter in service.
The next morning, I got to work as Rosie was getting out of bed. “Did you guys fly last night?” I asked as I dumped my groceries on the counter.
“Thank heavens, no,” Rosie said as she reached for the coffee pot. “Didn’t turn a rotor. First decent night’s sleep I’ve had for a week. Thank you, beeper gods.” We headed down to the helicopter for the morning’s preflight.
It was a beautiful, warm October day with clear skies, and by the time we were done with our morning duties, it was close to eighty degrees with a brisk wind from the south. California had been in the midst of a four-year drought, which turned the hills a deep golden color from the drying vegetation.
By lunchtime we were in quarters watching the news as we ate. There was a minor story about a small brush fire in the Oakland Hills, an area of swanky homes overlooking the East Bay and connected by narrow, winding roads. Tim watched the screen intently. “God help those guys if they ever get a real fire going up there,” he said. “They’d never get it out. Those fire trucks would never get up those tiny roads, and with this drought the whole state is one large tinderbox. Everything would explode.”
Mid-afternoon we were dispatched to Brines Reservoir Park for a mountain bike accident—a possible broken back. Brines Reservoir is one ridge past the Oakland Hills, and as we approached we noticed a small plume of smoke rising from Grizzly Peak. I contacted the fire department, who reassured us that a crew was already on its way. The small brush fire had reignited, but all was under control. Satisfied that things were in hand, we turned our attention to the landing zone.
We spotted the firefighter at the exact coordinates we had been given, and Tim made a few lazy circles before we landed on the open ridge top. I walked over to the firefighter and dropped the trauma bag heavily at my feet.
“Your patient should be here in a few minutes,” he said. “The medics were just finishing packaging him, and then they’ll bring him up here. He’s doing OK—moving all four—but he looks like he’s in a lot of pain.”
“We timed this well, then. Hey, have you seen the smoke from Grizzly Peak in Oakland?” I pointed to the wisp we had noticed on the way in.
“Yeah,” he answered, “I feel sorry for the guys in Oakland Fire. Must be ninety degrees out there by now. Won’t be much fun putting that thing out. But, thankfully, it’s not in our jurisdiction. We’ll call them tonight after dinner and see how things went.”
As we spoke, the ambulance came up the hill, groaning over every rut in the road. I could imagine that this short ride must be intensely painful for the patient as they bounced along the firebreak. Rose had come over to meet me, and together we loaded him into the aircraft for the eight-minute ride to the hospital. He was stable, but we needed a lot of morphine to keep him comfortable.
When we returned to the helicopter after dropping the patient at John Muir, we were stopped cold by the sight that met us as we walked out the ambulance doors. To the west, over the top of Grizzly Peak, a huge angry cloud of black smoke rose almost two thousand feet in the air. We stood and stared, dumbfounded, at the huge mushroom cloud. Tim wandered out from the cafeteria, carrying his ever-present cup of coffee. “Looks like that thing means business this time,” he observed.
We didn’t have a chance to respond because our pagers went off. We sprinted to the helicopter and cranked up the radios before starting the engines. “CALSTAR Base, CALSTAR One. Copy activation. Do you have further?”
“CALSTAR One, you have been activated to Grizzly Peak for an injured firefighter. Alameda County is declaring a level two disaster, and there are multiple agencies statewide responding, including CDF air ops. There are multiple aircraft in the area, and air ops are being coordinated by CDF on local frequency. We have been advised to have pilot contact CDF air ops prior to approaching area.”
“Copy for CALSTAR One. We have an ETA of eight minutes to scene. Will advise when we get airborne. Please contact both John Muir and Brookside for burns and check their availability.”
As we lifted off, the huge cloud of smoke appeared to be getting larger. We could clearly see walls of flame, hundreds of feet high, engulfing the hills. Trees dried by years of drought, especially eucalyptus, were exploding. We could see several helicopters circling the fire and dropping water from Bambi Buckets. These collapsible canvas buckets are suspended below the helicopter, and they’re filled by being dropped into a lake or pool. Once the pilot is over the fire, the bucket opens and releases the water.
For a few minutes, we were all speechless. “My Lord,” I breathed, “how can they possibly put this thing out?” A hot dry wind was whipping up, pushing the flames eastward toward the exclusive communities of Orinda and Moraga.
Rose dialed up Alco to receive instructions for our landing zone. The channel was flooded with traffic from all the ambulances, and we could hear requests to call in aid from around the state. We were beginning to understand the enormity of this fire and the potentially devastating impact it might have.
Seeing Alco was too busy to talk, Rose switched to the countywide fire frequency, which was just as jammed. We could hear the frantic calls of the firefighters requesting help. Some of them were withdrawing due to the intensity of the heat and flames that were rapidly spreading out of control. We heard the frustration and fear in their voices as everyone realized this was no longer a simple blaze. It was about to graduate to a firestorm.
Seven or eight helicopters flew over the area with buckets, and several fixed-wing air tankers were higher overhead. The smoke was obscuring a good deal of the sky by that point, and the aircraft were darting in and out of the active fire area, which now spread out over many square miles.
Tim turned us away from the fire and circled Brines Reservoir till the CDF’s air incident commander gave him a clearance into the area. We were buffeted by the winds as Tim initiated a high orbit. “Air Ops IC, this is CALSTAR One,” he squeezed in on the overburdened radio channel. “We are an EMS helicopter requested to fly into Grizzly Peak for evacuation of an injured firefighter. Please let us know when we are cleared into the area.”
“CALSTAR One, we have you in sight. Be advised about three-minute delay before clearance into fire zone. We have a tanker run lined up. As soon as he’s clear, we’ll get you in.”
Rose and I watched the aircraft swoop in and out of the smoke in seemingly random order. “Tim, how can we be sure we’re not going to run into one of those guys?” I asked anxiously. “They want us right up on the peak.”
Tim pointed to a small Cessna that was orbiting way above the smoke and confusion. “See that guy up there?” he asked. “He’s the air boss—the guy I was just talking to. His whole job is to coordinate all the aircraft and make sure nobody runs into anyone. It’s like having a moving air traffic control tower. But just the same, when we get cleared into the airspace, keep your heads up. There’s a lot going on, and instructions can be misunderstood.”
Eagle Five, the East Bay Regional Parks’ helicopter, happened to be orbiting nearby. Tom, an ex-CALSTAR pilot, came up on the radio to give us the lowdown on our LZ. “CALSTAR One, this is Eagle One. Come up on Victor frequency.” Tim acknowledged, and switched over to a frequency that was used pilot-to-pilot for unofficial business.
“Eagle Five, CALSTAR One. Is that you, Tom?”
“Hi, Tim, yeah. Listen, we were just into that LZ delivering equipment and personnel. You will be landing on a ridge that is just above Fish Ranch Road. There are wires to the south of Highway 24, but otherwise no obstructions. The LZ is marked by a fire truck, and the call sign is Engine 5357 on fire red.”
“Eagle Five, just how close is the fire to the LZ? Got a couple of nurses here that are very interested in that information.”
“Copy that, Tim. The fire is about half a mile away, and the flank seemed to be under control when we were in. Unfortunately, the fire has jumped Highway 24 and is now spreading toward Orinda. And with the winds it may be headed anywhere.”
“Thanks for the info, Tom. Gotta go—the air boss just cleared us into the area. Fly safe.” We made a steep left bank into the fire zone. “OK everybody,” Tim said over the intercom, “heads up. Keep radio traffic to a minimum.” There was a strained silence as we headed to our LZ. We all knew exactly where it was, as we drove along Highway 24 routinely. The freeway had now been shut down, and flying up the empty road I had taken to work earlier in the day was an eerie sight.
“Tim, I have our LZ on our right,” Rosie said, pointing through a blanket of smoke to a nearby ridge. A fire truck was parked off to one side, and we could see the firefighter on the ground giving us hand signals. The area did not appear to have burned, and I couldn’t see any flames nearby, much to our relief.
“Got it,” Tim said. “Let dispatch know we’re on short final.”
As Tim settled the helicopter on the ground, the entire peak above us was engulfed in flames, spreading several miles in either direction. As soon as Tim cleared us out of the helicopter, Rose grabbed the scene bag and headed over to the firefighter who landed us, with me on her heels. She greeted him with a smile.
“Looks like you guys are pretty busy,” she said. “Are they going to bring the patient here?”
The firefighter, who had his portable radio to his ear, motioned her to wait a minute. He listened intently, and then his hand dropped by his side. “The patient is dead,” he said shortly. “They have to leave the body where it was found. But they’re bringing you another guy that’s hurt pretty bad. They’ll be here in five minutes.”
I stopped and looked around at the incredible scene surrounding us. The roar of the fire alone made conversation difficult; we had to shout to be heard. Occasionally another tree would burst into flames, providing a background of steady explosions. Above, and moving away from us, was a wall of flames, now sending smoke thousands of feet in the air. The hillside was already burnt out, and a crew of firefighters painstakingly moved over the steep terrain with hoses and shovels, suppressing any hot spots. A tanker flew by only a hundred feet above us, preparing to drop another load. For now the wind was blowing the smoke away from us, but it could change any time and trap us in this LZ.
The firefighter cocked his head, then pulled the radio up to his ear. “Hold on a sec, I’m getting an update on your patient.” He listened intently for a few seconds, and I saw the expression on his face shift to one of deep anguish. “Never mind,” he said, looking at the ground. “He’s dead, too. They want to reposition you in the football field at Central High School for staging. You’d better get out of here anyway. The way the wind is blowing, this fire could go anywhere.”
Rose touched his arm. “I’m sorry,” she said, and together we headed back to the helicopter. We were quickly cleared out of the area by the air boss, who then inquired about our fuel status. Since we had just completed the flight for the bicycle accident when we were activated for the fire, we hadn’t had a chance to refuel. He directed us to Oakland Airport before stationing at Central High School. As we were cleared into Oakland, Tim gave us a rundown on how this was going to happen.
“You guys have never done a hot refuel, right? It’s a little weird, but remember these guys do it all the time. We have to be quick to allow the next aircraft in—they need to stay in the air as much as possible before the sun goes down. Just stay buckled in your seat, and if there’s any problem, be prepared to exit quickly. Like if there’s a fire. But don’t worry, these guys really know what they’re doing.”
“Tim,” I said, “I know you’re trying to make us feel better, but it’s not helping.”
“Just stay put and keep out of their way,” he answered as we landed.
It was pretty scary. Two fire engines pulled up and trained their hoses on the helicopter. The fuel truck pulled up and within a minute they were pumping Jet A into the tanks—with our engines still running. As the refueler was finishing up and replacing the gas caps, Tim was pushing the throttle forward and we were in the air in seconds. I barely had time to glance out the door to make sure the gas cap was indeed on securely. The whole episode lasted less than five minutes.
“Pretty slick, huh?” Tim asked as we were airborne again heading toward the staging area.
“Actually,” I replied. “I’d rather not do that again if we don’t have to.”
As we approached Central High from the Bay, the brisk winds blew all the smoke off to the west, giving us a clear picture of just how large the fire had become. The entire backdrop to Oakland was either on fire, or just smoking remnants of what used to be lovely homes. We all stared out the window, astonished by what we could see. Fire trucks and police cars at the edges of the fire looked like ants attacking an animal fifty times their size. Even to my uneducated eye, it was clear that things were wildly out of control.
We were asked to land in the football field and then come to the makeshift headquarters for a meeting at 4:00 p.m. to try and organize all our resources. When we were shut down, Tim stayed with the aircraft while Rose and I headed off to what was to be the first meeting of many that afternoon. The roar of the fire, along with regular explosions, still made talking difficult. The scene on the street was chaotic. Smoke filled the air and ashes fell steadily from the sky. Hundreds of people, many of them newly homeless, milled around, watching helplessly as their homes and businesses went up in flames.
The Red Cross was busy handing out coffee and sandwiches and setting up cots in the gymnasium for the displaced people. A semi truck from Safeway, a local grocery chain, pulled up and started an impromptu human chain to offload food and supplies for anyone who needed it. Down the street, the hamburger joint kept busy handing out burgers and fries to the disaster victims and workers. Firefighters from all over California were showing up on their own, carrying shovels, picks and axes, anxious to help.
After the meeting, we stood by at the helicopter, ready to go when needed. The plan was this: An ambulance would drive any serious casualty to the football field, and then we would fly them out to the closest appropriate facility. However, the news we got at that first meeting was that the smoke and fire were looming dangerously close to Children’s Hospital, and they were considering evacuating all the patients—including the neonatal intensive care unit. Many of those tiny infants were too unstable to turn, much less be transported. Apparently, smoke was being sucked into the hospital’s air vents, making it hazardous for both the patients and the staff. To make matters worse, I grimly reminded the incident commander, Children’s did not have a helipad.
For the time being, there was nothing we could do but sit and wait. We collected some food and a Thermos of coffee, and camped out in the field, watching Oakland burn. Several times we were notified that we had a potential patient, but each time we were stood down. Either they were minor injuries, or they were dead. If they were dead, the police left the bodies where they lay to assist the coroner’s office in the coming days. It was incredibly frustrating. Fortunately, though, the fire had taken a turn westward, and they didn’t need to evacuate Children’s
after all.
The afternoon turned into night and as the sky darkened, the constant roar of the fire helicopters ceased, as they could no longer fly safely. A stillness settled onto our football field, punctuated by an occasional explosion, and the sky turned an eerie orange from the flames. The brisk wind finally died out, allowing the fire department to start getting the inferno contained.
At nine o’clock we were released. While the firefighters still had a long night ahead of them, the fear of major injuries had passed. We slowly gathered up our belongings and lifted off toward base. Everyone was very quiet. “What a day,” Rosie remarked. “I think I want to go back to Tampa.”
When we got back to quarters, it was time for a pilot change, and Pete was waiting to take over. Before he left, Tim hugged us both. “You guys realize there wasn’t a damn thing you could have done for those firefighters. We did what we could.” I knew that, but somehow it didn’t seem like we’d done enough.
At 10:00 p.m., the phone rang. Rose answered it, expecting to be dispatched back to the fire. “Where in Oakland do they want us?”
“You’re not going to Oakland,” said Elise, our dispatcher. “You’re headed to Half Moon Bay for a suspected SIDS.”
We jogged out to the helicopter, belted in, and were off into the night sky. I was already emotionally drained from the disaster we had witnessed that day, and now we were going to pick up a victim of SIDS, or sudden infant death syndrome. I felt my brain go into automatic mode. I was going to have to concentrate on the mechanics of a full-blown code for an infant.
I hated these calls; they were usually horror shows. Most SIDS infants are long gone before anyone finds them, and we can do nothing for them. But they’re babies, and we often carry on a code long after it’s clear that the child is dead. After the baby is pronounced, our job is then to support the grieving parents. And that’s the most difficult part of all.
As we headed for the coast, Rose reached over and squeezed my hand. “Are you OK to do this?” she asked. “If you want, I’ll do primary.”
“It doesn’t matter. We’ll both have a lot to do if this baby really is a full arrest. But I’m going to need you when this flight is over. Not a good day today.” We were both quiet as we flew on, setting up our equipment and calculating drug doses.
We found the LZ easily as we passed the last ridgeline to the coast. After we landed, I grabbed the scene bag and headed for the ambulance, which pulled up as we landed. As soon as I opened the ambulance doors, I knew this was as bad as it could get. One paramedic was doing chest compressions with the infant on his lap. The baby wasn’t intubated, and they had been unable to establish an IV—always difficult to do in infants. As I crawled in, they gave me a brief report.
“This is a two-month-old female that was found unresponsive by the grandparents about half an hour ago. She was a normal pregnancy and delivery, and apparently has been healthy until tonight. They started CPR right away, and fire was on scene in less than ten minutes. We’ve been unable to intubate her and can’t find any IV access.” While he was talking, I pulled out my equipment, preparing to intubate her while he talked. I gently inserted the laryngoscope blade into her mouth and was able to see the vocal cords. Unfortunately, a huge cascade of milk erupted from the esophagus, obscuring my view.
“Suction,” I said urgently, holding out my hand while trying to keep a visual on the cords. Rose, who had just got into the ambulance, reached over, turned it on, and handed it to me. I gently suctioned out the baby’s airway, and pushed the tube down through the cords into the trachea. I withdrew the blade and, still holding onto the tube, had the paramedic start bagging. We had good chest rise and could hear breath sounds.
As I taped the tube I said, “Rose, try and get an intra-
osseous line. These guys haven’t been able to find a vein, so let’s not waste any more time. In the meantime, get me some epine-phrine; we’ll give it down the endotracheal tube. When you get the IO line established, we’ll give a full round of drugs.”
The paramedic handed me some drugs, which we squirted down the ETT. “We figure she’s about five kilos,” he said. He then hooked her up to their monitor. Not surprisingly, it showed asystole, or flat line.
“You guys ever have a heart rhythm?” I asked.
“No, nothing but asystole,” he said. I looked out the back window of the ambulance and saw an elderly couple straining to see inside. They were clearly panic-stricken, and tears rolled down their cheeks. I nodded toward the window.
“Is that the family?” I asked the medic, who was reinforcing the tape on the endotracheal tube.
“It’s the grandparents,” he said. “They were babysitting while the mom and dad went out to dinner for the first time since she was born. They found her unresponsive in the crib and were absolutely frantic. They probably think they’re responsible for all this. We tried to tell them this isn’t their fault, but you know how that goes.”
“We’re going to Peninsula Hospital. Can you make sure they don’t get into the car and try to drive over themselves?”
“Don’t worry, we’ll bring them.”
“Great. Also, our flight time is only going to be about six minutes, so could you call ahead for report?” I asked, gathering up our stuff.
By this time, Rose had the intraosseous line established, and gave the first round of drugs. Predictably, there was no change. We laid our tiny patient on a backboard and prepared to load her into the helicopter. I looked over at Rose. She was focused on the child with an expression of deep anguish in her eyes. She glanced up at me. We both knew this child was dead.
Our flight over to Peninsula was quiet, with only murmured communication as we went through the motions of running the arrest. Not surprisingly, there was no response to our efforts. When we landed at the hospital, we unanimously decided to offload cold, or with the engines shut down. There was no point in endangering the staff under moving rotor blades. Rose brought a nurse over to do compressions while I carefully unhooked the baby from the monitors.
When we pulled into the ER, the team pulled out all the big guns, stopping only short of opening her chest for internal cardiac compressions. There was no response, and she was declared dead some twenty minutes later. In the meantime, the entire family had arrived, including the parents. They were quickly whisked away by pastoral care, but I still heard the screaming wail when the baby’s mother heard the news. There is nothing quite as heart-wrenching as the cry of parents who discover their child has died.
One of the nurses came into the radio room where we were trying to chart. “We’re going to be doing postmortem care in a minute. Would either of you like to come spend a few minutes with her before we send her to the morgue?” This was fairly common practice, particularly with children. We often only dealt with them in the middle of chaos, so it was a way to find some peace.
I looked at Rose. Her eyes were red and tearing, and she shook her head. “Can’t do that,” she said, and turned her head away. A tear slid down her cheek and blurred the ink on the chart.
I followed the nurse into the trauma room, and she left me alone with our tiny patient. She was lying on the gurney with the endotracheal tube and intraosseous line sticking out at unnatural angles. She was very pale and appeared to be sleeping. I gathered her up in my arms, taking care not to dislodge the lines. “I’m sorry,” I said, gently stroking her head. “We tried everything we could, but we couldn’t get you back. I’m so sorry.” I rocked her for a while, crying silently as the events of the last twelve hours came flooding back. I gently laid her back on the bed and walked out of the room, shutting the door quietly behind me.
While we were flying home that night we could see the fire still smoldering in Oakland, but by now it was only red at the edges; there were no more hundred-foot sheets of flame. A huge patch of the Oakland Hills, normally covered with the small twinkling lights of homes, was now lit only by the glow of red emergency beacons.