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Not Until Cairo: A Flight Nursing Tale
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Not Until Cairo: A Flight Nursing Tale

Nursing, nursing stories

Not Until Cairo: A Flight Nursing Tale

Worsening signs.

The author’s flight path circled the globe

The cabin of the Learjet is dark, the heart monitor a metronome over the drone of the engines and pulse of the mechanical ventilator. I’ve been watching my patient’s cardiac rhythm, with ominous hackles rising on the back of my neck while my partner naps. Over the course of the journey the man’s inherent tachycardia has slowly shifted into a sinus rhythm that might seem like normalization on a paper medical report, but feels wrong. After all, this patient is dying. He is returning to Egypt to die amongst family after last-ditch cancer treatments in America have failed.

“Not on this flight,” I think to myself. “Not until Cairo.”

The plane banks as it descends into the Newfoundland night. The cabin vibrates with turbulence; St. John’s may be the most easterly North American fuel stop, but its position on the Atlantic all but guarantees unpredictable weather. The lights of the town sparkle below as my partner rouses, pops his ears, and stretches.

“Look at his heart rate,” I say, quietly. “Pressure’s okay, though.”

“Yeah,” he says. There’s an unspoken accordance between us. We’ve flown together enough—been trapped in small planes for countless hours, evaluating and collaborating—that we […]

Marcy Phipps, BSN, RN, CCRN, CFRN2018-06-21T10:11:27-04:00June 21st, 2018|Nursing, nursing stories|4 Comments

Nursing Reads: A Powerful New Novel Evokes Diverse Perspectives on an Organ Transplant

By Marcy Phipps, BSN, RN, CCRN, chief flight nurse at Global Jetcare

The Heart, a new novel by Maylis de Kerangal, caught my attention with a cover art image suggestive of the vascular and as beautiful as an angiogram. Taking place over a 24-hour period, the novel describes a 19-year-old accident victim who suffers brain death and the people who are connected to the heart transplant that follows: his parents, the doctors and nurses, the recipient of the heart. As a nurse who’s seen the organ transplant process from a number of angles, I wasn’t sure how De Kerangal could possibly navigate such material.

But the novel, which has been ably translated from French, is both subtle and powerful, casting light on the complexity of every character, from the pre-accident vitality of Simon, the donor, to the conflicted gratitude of the heart recipient; from the inexperienced ICU nurse to the surgeons.

Two important characters are nurses, though they are only a part of the larger picture:

Cordelia Owl, Simon’s ICU nurse, is an inexperienced practitioner. She carries out her nursing tasks in a distracted, perfunctory manner, speaking aloud to the unresponsive Simon as she cares for him. In doing so, she inadvertently intensifies the anguish of his parents, who are standing nearby and struggling with the concept of brain death.

Though her behavior shocks the attending physician, she’s […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:01:25-05:00February 29th, 2016|Nursing, nursing perspective, patient experience|0 Comments

Rightness: A Flight Nurse Taps Into the Universal Language of Nursing

“Immersed in a nursing role that I didn’t even know existed when I entered the profession, I find there to be a common language—one rooted in science but strongest in humanity and compassion, transcending culture, geography, and words.”

By Marcy Phipps, BSN, RN, CCRN, chief flight nurse at Global Jetcare

I’m standing in the doorway of our plane, watching our patient sleep and eyeing the monitor. The monitor’s beeps keep steady time and mix with the sounds of the pounding waves that batter the atoll.

We’ve stopped for fuel on this narrow runway that stretches down a spit of land in the Pacific. As the sun rises we snack on cold gyudon, a Japanese dish we picked up in Guam. It’s not the best breakfast, but somehow feels right—like a lot of other aspects of this job lately.

We’d started our mission in eastern Asia, picking up an American citizen who’d fallen ill in a city that didn’t cater to tourists and where almost no one spoke English.

While there, our crew’s handler—someone whose job it is to facilitate our lodging, transportation, and generally ease our way—had taken us to a dimly lit restaurant on a back street and treated us to a myriad of local delicacies, some of which I recognized, many of which I didn’t. My usual morning run had led me through parks and a street market […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:01:31-05:00February 1st, 2016|nursing perspective|4 Comments

Thanksgiving in the ICU: Woven into the Tapestry of Traditions

By Marcy Phipps, BSN, RN, CCRN. Editor’s note: This post, originally published in 2011, remains as timely as ever. The author is now chief flight nurse at Global Jetcare.)

cranberries

I’ll be working this Thanksgiving. I’ve worked so many Thanksgivings that the ICU feels woven into the tapestry of my own traditions. I don’t really mind; the cafeteria serves a fitting feast that’s embellished by the homemade treats we bring in, and although we won’t actually be watching it, the Macy’s parade will be on. Somehow, the smells and sounds I associate with the holiday will mix and mingle with the usual bustle of critical care, and it’ll feel like Thanksgiving. It’s actually a nice day to be at the hospital—for the nurses, that is.

For our patients and their families, I know hospital holidays fall far short. We have one patient, in particular, who’s been with us for a while. Her husband’s been a fixture at her side throughout her stay, and I expect to find him stationed there this Thanksgiving. Hospital turkey and television won’t give him the comfort or peace that he seeks, and I don’t know that he’ll be giving thanks. For many weeks I’ve watched him skirt a fine line between gratitude and despair; things could always be worse, but they could certainly be better.

When I stop to count my blessings, I’m overwhelmed. I belong to a profession that I’m passionate about—one that brings me great […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:01:43-05:00November 25th, 2015|career, narratives, nursing perspective, patient engagement|2 Comments

The Underlying Connection Is Nursing

photo by author

Marcy Phipps, BSN, RN, CCRN, ATCN, TNCC, an ICU nurse who recently took up flight nursing, is an occasional contributor to this blog.

I recently experienced a series of events that seemed interconnected and orchestrated.

It started with my usual morning run. I was jogging out of my neighborhood, already sweating in the summer heat and absorbed—coincidentally—in an audio podcast about trauma care, when I came upon a man sprawled in the middle of a usually very busy thoroughfare. His motorcycle, badly damaged, was lying on its side next to a car with a crumpled door panel. The accident had clearly just occurred—traffic hadn’t yet backed up and no sirens could be heard heralding imminent assistance.

I had the weird sensation that I’d been running to the accident all along. I held his C-spine and monitored his neuro status while an off-duty paramedic managed the scene. Unexpectedly, a cardiologist I sometimes work with emerged from a nearby café and held his fingers to the man’s radial pulse, and then several more off-duty paramedics arrived.

It seemed fortuitous to me at the time—not the accident, of course, but the proximity of medical personnel who were so quickly available. And I had the impression that, despite not having worn a helmet, the motorcycle rider would be okay. […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:03:52-05:00September 22nd, 2014|career, narratives, Nursing, nursing perspective, Patients|12 Comments

Flight Nursing Notes – The Feel of a Homecoming

Observations of an experienced ICU nurse and long-time AJN blogger who recently made the transition to flight nursing.

Marcy Phipps, BSN, RN, CCRN, ATCN, TNCC, is an occasional contributor to this blog. Some details have been changed to protect patient privacy.

“We’ve been married for 58 years,” my patient’s wife says. “Fifty-eight years…”

She turns her attention from me and gazes out the window of the plane.

We are on a medevac flight, 35,000 feet over the Pacific en route to an urban, American hospital near “home.” Her husband is being transferred to receive aggressive care for a grave illness.

We collected him hours earlier from a hospital on a foreign island. Local paramedics picked my partner and me up from the barren, windy tarmac. As we sped to the hospital in the back of an ambulance with a cracked windshield, the driver turned to warn us that we were going to “the worst hospital in the city.”

“It’s open-air,” he told us, as he dodged mopeds and swerved through narrow, crowded streets.

This didn’t surprise me. I’d been forewarned that hospital conditions on many of these remote islands could be shocking when compared to American standards. It was something I’d been curious to see firsthand.

Yet when we picked our patient up, we found him in a small and clean room in an intensive care unit. Despite the paramedic’s prediction and […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:04:17-05:00July 14th, 2014|career, Nursing|3 Comments

Not Compatible With Nursing

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” was published in the May (2012) issue of AJN.

Photo by the author

“His family knows this is not a survivable injury, right?”

This question, posed to me in the doorway of my patient’s room by a trauma surgeon I regard as brilliant, caught me off guard.

“No,” I said. “They don’t know that.”

He frowned at me, mumbled something about false hopes, then moved away to continue his rounds.

This wasn’t the only physician who’d expressed a strong opinion regarding my patient’s mortality—a consultant had deemed his injuries “not compatible with life.” But I’d been caring for this man, as a 1:1 assignment because of his high acuity, for every shift for weeks. It seemed obvious to me that my patient’s continued presence in the ICU—and his relative stability on that particular day—directly opposed the dire predictions. The man’s family did not see his situation as hopeless, and neither did I.

And yet days after the surgeon uttered those words, my patient suffered a complication and became so unstable that for hours he teetered between life and death. The resuscitation effort was massive—and no one mentioned survivability. No one behaved like there was even a shred of futility in bringing […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:05:28-05:00February 5th, 2014|career, nursing perspective|5 Comments

Taking Flight: A Nurse Recharges Her Batteries

By Marcy Phipps, RN, a regular contributor to this blog. Her essay “The Love Song of Frank” was published in the May (2012) issue of AJN.

interior, BK 117 medical helicopter

You’re part of a fixed-wing flight transport team called to pick up a 32-year-old male who’s been involved in a paragliding accident in Puerto Rico. Upon landing, you see an ambulance at the end of the tarmac. As you exit your plane, the ambulance pulls up and the crew opens the back door of the rig. They pull the patient out on a stretcher and hand you a folder of X-rays, saying, “He’s all yours.”

After four days of intensive training in the Air Medical Crew Core Curriculum course, my team was given that scenario as a group assignment on the last day of class. We were given a folder of radiology films and briefed on our patient’s vital signs and our assessment findings. We conducted a quick “field interpretation” of his X-rays and presented our interventions, along with our concerns and specific accommodations for transporting this unstable patient to Florida in a Learjet.

This was no ordinary class. Offered to nurses and […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:06:38-05:00September 9th, 2013|career, nursing perspective|1 Comment

Something Like Grace

By Marcy Phipps, RN, a regular contributor to this blog. Her essay “The Love Song of Frank” was published in the May (2012) issue of AJN.

Mark was in town to be the best man in an old friend’s wedding—on a vacation, of sorts—when the unthinkable happened and he was involved in a horrendous traffic accident. He was ejected from his rental car. His injuries were severe and life threatening.

Mark’s family was halfway across the country. Getting to Mark quickly seemed impossible. But this is where the story takes a turn:

Mark’s family found a flight leaving that morning from their local airport, with the exact number of available seats that they needed. As they bought the tickets, they explained the nature of their emergency. They got to the airport in the nick of time. While checking in, they were approached by an airline employee who asked if they’d already arranged a rental car. They told him that they hadn’t—they hadn’t even stopped to get their clothes.

They didn’t know it at the time, but the employee who’d approached them was the pilot of the plane. He’d learned of the family emergency and held the plane for them. He knew how serious Mark’s accident had been, as he’d happened to drive right past the accident scene on his way to the airport before the first leg of the flight.

When the plane landed, the pilot requested that Mark’s family […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:06:57-05:00July 22nd, 2013|nursing perspective, Patients|4 Comments

Get the Job Done

By Marcy Phipps, RN, a regular contributor to this blog. Her essay “The Love Song of Frank” was published in the May (2012) issue of AJN.

Nursing students, 1918/Cornell University Library/via Flickr

I remember being a new nurse and having an order to place a Foley catheter in a female patient.

I was filled with dread. Urinary catheter placement was the only skill I’d failed in nursing school (I’d contaminated my sterile field), and placing a catheter in this patient was sure to be a challenge, as she was obese and unable to cooperate. It was not a one-person job, even for a far more experienced nurse.

When I asked a coworker for help, she sighed and said, “I don’t have time. This isn’t nursing school, you know. You just do the best you can and get the job done.” […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-29T13:33:01-05:00July 8th, 2013|nursing perspective, nursing stories|3 Comments

Worsening signs.

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