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The
following
is
an
excerpt
from
50
Flights:
A
Physicians
Coming
Of
Age
I
must
now
go
a
long
way
.
.
.
I
must
face
fighting
such
as
I
have
not
known,
and
I
must
travel
on
a
road
that
I
do
not
know!
~The
Epic
of
Gilgamesh,
Tablet
III,
2100
B.C.
I
was
rummaging
around
the
external
compartments
of
the
helicopter
as
sweat
dripped
down
my
face.
The
heat
was
unbearable,
and
my
slippery
fingers
had
trouble
grasping
when
my
radio
toned.
Time
to
fly.
The
heat
inside
the
hangar
was
stifling.
It
would
be
our
third
flight
that
day
and
the
veil
of
fatigue
that
inevitably
descends
after
twelve
hours
of
intense
stress
was
beginning
to
take
its
toll
on
my
spirit.
I
raced
inside
with
the
enthusiasm
of
a
small
child
and
took
the
call.
Flying
never
got
old.
I
love
the
rush
of
adrenaline
from
takeoff
and
the
thrill
of
speed
coupled
with
the
chance
to
use
my
medical
skills.
Immediately
a
sense
of
dread
overtook
me.
I
could
feel
an
unwelcome
pit
open
in
the
bottom
of
my
stomach
as
I
listened
to
the
physician
on
the
other
end
of
the
phone
relate
the
brutal
details.
Some
cases
are
more
emotionally
charged
than
others.
This
one
would
prove
to
be
one
the
hardest
cases
Ive
yet
to
have
in
my
career.
A
story
unfolded
that
a
six-year-old
child
had
been
playing
in
the
yard
and
had
apparently
wandered
out
onto
the
road.
The
family
lived
in
a
somewhat
remote
area,
and
it
was
not
unusual
for
cars
to
travel
in
excess
of
60
miles
an
hour
on
the
gravel
road
in
front
of
their
home.
As
suppertime
time
approached,
the
father
went
out
to
find
his
son
and
couldn't
locate
him.
As
he
walked
down
the
road
calling
his
sons
name,
he
found
a
single
shoe.
He
immediately
began
screaming
for
help!
The
child's
mother
and
several
older
siblings
raced
out
and
began
to
scour
the
immediate
area.
They
soon
located
the
child
on
the
opposite
side
of
the
road
crumpled
in
the
ditch.
There
lay
their
precious
childbattered
bruised,
bloody,
and
unconscious.
A
senseless
victim
of
another
hit
and
run.
The
local
ambulance
crews
responded
quickly
and
found
a
shattered
family
holding
their
precious
soul.
A
paramedic
scooped
the
child
from
the
sobbing
father's
arms
and
ran
back
to
the
ambulance
for
a
short
transport
to
the
local
hospital
where
the
ER
staff
immediately
took
over.
They
secured
his
airway
with
an
endotracheal
tube
and
inserted
several
IVs
into
his
arms
to
begin
the
process
of
pouring
life-giving
blood
and
fluids
into
him.
These
are
standard
but
critical
actions
in
an
attempt
to
save
this
fragile,
precious
little
life.
The
size
of
the
child
and
the
critical
nature
of
his
injuries
only
compounded
the
difficulty
in
this
case.
The
clicking
sound
of
his
shattered
ribs
along
with
dramatic
bruising
on
his
torso
and
abdomen
signaled
horrific
injuries
below.
His
small
body
was
no
match
for
the
speeding
metal
of
a
passing
car.
As
we
landed
and
exited
the
aircraft,
the
paramedic
gave
me
a
knowing
look.
We
had
dealt
with
children
in
critical
condition
before,
but
this
was
going
to
be
different.
We
entered
the
back
of
the
emergency
department
and
felt
an
overwhelming
somberness
like
a
thick
layer
of
fog.
The
child's
condition
had
rapidly
deteriorated
since
our
initial
phone
call.
The
endotracheal
tube
was
leaking
and
forced
bubbles
of
blood
from
the
child's
mouth.
Both
parents
were
at
the
bedside,
sobbing.
The
father
repeating,
over
and
over
again,
"My
big
boy,
don't
leave
me."
As
our
team
began
to
assist
in
the
care
of
this
patient,
I
could
feel
the
tears
welling
up
in
my
eyes.
I
had
just
recently
experienced
the
birth
of
my
child,
who
was
now
just
a
few
months
old,
and
I
called
him
"big
boy."
Every
time
the
father
would
say
those
words,
"My
big
boy,
don't
leave
me,"
I
could
feel
my
heart
strings
being
tugged
even
harder.
An
intense
focus
was
required
to
stay
on
task.
It
was
apparent
that
we
needed
a
different
endotracheal
tube.
I
instinctively
took
control
over
the
airway
and
began
preparations
to
place
a
larger
tube
to
better
secure
the
airway.
His
oxygen
level
was
dropping,
and
we
had
to
act.
In
trauma,
the
airway
takes
precedence
over
all
and
is
the
first
step
in
managing
critical
cases.
As
I
looked
into
the
back
of
the
throat
with
the
laryngoscope,
I
was
met
with
an
angry
pool
of
blood.
With
some
difficulty,
I
was
able
to
visualize
a
sliver
of
the
epiglottis
and
see
the
leaking
endotracheal
tube's
location.
I
gave
my
paramedic-nurse
the
nod
to
pull
the
tube
and
then
I
deftly
slid
in
the
larger
tube
to
secure
the
airway
following
alongside
the
old
tube
as
it
was
pulled
from
his
lungs.
My
sense
of
accomplishment
and
relief
at
completing
this
vital
task
was
short
lived.
We
began
the
process
of
transferring
the
child
to
our
stretcher
when
he
flatlined.
The
local
physician
began
to
pump
vigorously
on
his
chest,
trying
to
usher
life
back
into
his
fragile
little
body.
Statistics
show
that
any
person
who
suffers
cardiac
arrest
from
trauma
has
a
very
poor
outcome.
This
case
was
no
different,
but
all
healthcare
providers
I
had
trained
under
always
gave
children
the
extra
benefit
of
the
doubt.
These
little
souls
had
not
yet
lived
or
experienced
the
joys
of
life
and
terminating
resuscitation
efforts
in
any
child
is
a
difficult
decision.
Even
if
all
the
evidence
supports
that
the
case
is
futile,
we
continued
throwing
all
the
technology,
medication,
knowledge,
and
skill
into
the
arena
-
hoping
that
there'll
be
some
positive
response.
Letting
hope
take
precedence
over
the
science
and
any
statistic,
even
if
just
for
a
fleeting
moment.
All
we
ask
is
just
some
small
glimmer
of
hope
or
even
the
slightest
hint
of
response
showing
that
we
can
bring
this
child
back
from
death.
After
what
seemed
like
an
eternity,
we
all
knew
it
was
time
to
stop
the
resuscitation
efforts.
We
had
lost.
Time
stood
still,
and
final
act
was
rapidly
drawing
to
a
close.
I
asked
the
social
worker
to
escort
in
the
grandparents.
We
had
been
alerted
to
their
presence
only
moments
before
and
sensed
they
would
want
to
be
at
the
bedside.
I
stepped
away
from
the
head
of
the
bed,
as
did
many
of
the
other
staff,
with
the
exception
of
the
physician
who
was
still
performing
chest
compressions
and
the
therapist
who
was
pushing
oxygen
into
this
child's
tiny
lungs
with
a
bag
valve
mask.
The
best
efforts
of
our
team
had
failed.
The
family
crowded
around
the
bedside,
each
taking
a
hand
of
the
child
and
gently
stroking
his
face,
but
among
all
the
outpouring
of
love,
tenderness,
and
grief,
its
the
father's
final
words
I
will
always
remember.
As
we
stopped
resuscitation
efforts,
he
whispered,
"My
big
boy,
I'll
always
love
you.
Forever."
And
with
that,
he
leaned
down
and
kissed
his
child
good-bye.
I hope you enjoyed this mission and have gained an understanding for life
on the front lines of emergency medicine and trauma care.
Please share this if you enjoyed it.